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Racial and ethnic disparities in health outcomes and quality of care have been consistently observed among people who have similar health insurance, are within the same system of care, and even within the same health plan. Unfortunately, national efforts to eliminate these disparities are hampered by the lack of race/ethnicity data. Health insurance plans can play a critical role in reducing these disparities by developing and using viable data for quality improvement, asserts Arlene S. Bierman, M.D., M.S., of the Center for Outcomes and Effectiveness Research, Agency for Healthcare Research and Quality.
In a recent paper, Dr. Bierman and her colleagues provide an overview of issues related to the use, collection, and interpretation of racial and ethnic data in health care settings. The paper reports on discussion at a June 1999 meeting sponsored by the U.S. Department of Health and Human Services and the Commonwealth Fund, as well as ongoing activities in this area. Participants from managed care organizations, purchasers, and Federal agencies underscored the value of these data to efforts to eliminate health disparities and the importance of consensus-building among patients, providers, insurers, and public and private purchasers about data collection and use.
Managed care plans can use data on the race and ethnicity of enrollees to:
- Inform program development, planning, and priority setting.
- Target quality improvement efforts.
- Understand differences in performance within a plan.
- Understand the health needs of specific populations and develop appropriate interventions.
- Identify the need for and deploy resources to provide culturally and linguistically appropriate services.
- Evaluate and monitor the effectiveness of interventions.
Lacking a uniform data collection infrastructure, health plans use a variety of strategies to collect race/ethnicity data: electronic medical records, administrative data, enrollee surveys, data linkages, and Federal and State enrollment files for Medicare and Medicaid beneficiaries, respectively. Perceived barriers to routine collection of race/ethnicity data include uneven data quality, legal issues, concerns about confidentiality and privacy, potential for misuse, public reporting, and cost. Nevertheless, various strategies are available to overcome these barriers, and collection of racial and ethnic data may be considered an integral component of activities targeting the elimination of disparities in health care.
See "Addressing racial and ethnic barriers to health care: The need for better data," by Dr. Bierman, Nicole Lurie, M.D., Karen Scott Collins, M.D., and John M. Eisenberg, M.D., M.B.A., in the May 2002 Health Affairs 21(3), pp. 91-102.
Reprints (AHRQ Publication No. 02-R065) are available from the AHRQ Publications Clearinghouse.
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