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Reports show few health care disparities eliminated, persistent variations in care, and slow pace of improvement

Research Activities, June 2009, No. 346

Racial, ethnic, and income-based disparities have been eliminated in some areas of health care. Yet, significant variations in the quality of and access to services remain, particularly in such areas as prenatal care, preventive screening, and mental health treatment, according to annual reports released by the Agency for Healthcare Research and Quality (AHRQ). The 2008 National Healthcare Quality Report shows that health care quality continues to improve at a slow pace. For example:

  • Care delivered in hospitals improved at an annual rate of nearly 3 percent, the highest among care settings.
  • Care provided in doctors' offices and other outpatient settings improved at a rate slightly over 1 percent.
  • Patient safety rates (protecting patients from injury due to medical care or medical errors) declined by nearly 1 percent.

Receipt of needed services also varied widely. For example:

  • 40 percent of recommended care was not received by patients.
  • Heart attack patients received 95 percent of recommended services, but only 15 percent of dialysis patients were on a transplant waiting list.
  • Seven out of 10 adults with mood, anxiety, or impulse disorders received inadequate or no treatment.

The 2008 National Healthcare Disparities Report found that improvements in preventive care, chronic care, and access to care have significantly reduced disparities in:

  • Rates of mammography in Asian, American Indian, and Alaska Native women.
  • Smoking cessation counseling in low-income adults.
  • Appropriate timing of antibiotics to prevent surgery-related infections among American Indians and Alaska Natives.

At the same time, most of the largest disparities have not changed significantly. For example:

  • The proportion of new AIDS cases was 9.4 times higher for blacks and more than three times higher for Hispanics than for whites.
  • American Indian and Alaska Native women were twice as likely to lack prenatal care as white women.
  • At least 60 percent of quality measures have not improved for minorities compared to whites in the past 6 years.

Editor's Note: AHRQ's Quality and Disparities Reports, which are mandated by Congress and were first published in 2003, are read widely by policymakers, health care analysts, public health advocates, health insurers, journalists, and consumers. The National Healthcare Quality Report synthesizes 220 quality measures, which range from how many pregnant women receive recommended prenatal care to how many elderly receive pneumococcal vaccinations. The National Healthcare Disparities Report summarizes which racial, ethnic, and income groups are benefiting from improvements in care. Both reports draw on data from more than three dozen databases, most sponsored by Federal health agencies. The reports are available online at or directly from the AHRQ Publications Clearinghouse.

Page last reviewed June 2009
Internet Citation: Reports show few health care disparities eliminated, persistent variations in care, and slow pace of improvement: Research Activities, June 2009, No. 346. June 2009. Agency for Healthcare Research and Quality, Rockville, MD.