Organizational Affiliation: The George Washington University Medical Center; Center for Health Services Research and Policy and the National Association of Community Health Centers
Author: Peter Shin, Karen Jones, and Sara Rosenbaum
Date: September 2003
Contact Information: Peter Shin, The George Washington University Medical Center School of Public Health & Health Services, 2021 K Street NW Suite 800, Washington, DC 20006
Pages: 21
Content Summary
This report explores the effect of health center penetration on medically underserved populations and its effects on racial and health disparities. The researchers address the first six of the ten ambulatory care sensitive health indicators identified by Healthy People 2010. These include infant mortality, total age-adjusted death rate, age-adjusted heart disease death rate, age-adjusted diabetes related death rate, tuberculosis case rate, and adequacy of prenatal care.
For each of the health indicators the rates of Whites were compared to those of Blacks and then to those of Hispanics to reveal the health disparities and their connection to health center use. In the discussion of the Black/White health disparities the focus is on infant mortality, prenatal care, and total death rates. In the discussion on Hispanic/White disparities the researchers discuss prenatal care and the tuberculosis rate.
The report includes an executive summary, a background and overview of the project, a discussion of the methods, a discussion of the findings and a conclusion. A series of health care interviews were also conducted as a part of the research and the results from these interviews are included in this report. The authors end the report by addressing the key limitations of the study.
Major Findings
The researchers found a significant relationship between health center penetration and a reduction in racial and ethnic health disparities for infant mortality for Black patients, prenatal care, tuberculosis rates for Hispanic patients, and overall death rates for Black patients.
The Black/White disparities were reduced based on health center penetration. The disparity between black and white infant mortality was the smallest in states with the greatest health care center penetration. For example in most states including Florida, Maryland, Michigan, New Jersey and Tennessee, which have 10% or less health center penetration the disparity in infant mortality between Whites and Blacks is 8 ½%. However, in Colorado, Massachusetts, Rhode Island, Washington, and West Virginia each of which has 20% or greater health center penetration the disparity was merely 7%. A similar trend is shown for prenatal care access and quality and most promising for the reduction in total death rates.
Similarly, the Hispanic/White health disparities were also reduced according to health care penetration. There is a four point reduction in the prenatal care disparity from least to greatest health center penetration. The tuberculosis rate disparity showed the same trend. In most states with 10% or less health center penetration the disparity was eight and a half whereas in states with 20% or greater health center penetration the disparity was merely six and seven tenths.
The study reveals that Medicaid by itself has no significant effect on health disparities and health center penetration has the least impact on racial disparities in diabetes and cardiovascular death rates.
The discussion of the health care interviews outlines major health risks, contributing social factors and health center interventions that health centers addressed to decrease the risks minorities face.
The authors suggest that the combination of clinically customized and supported health care and comprehensive health insurance are required for the most significant medical care strategy in eliminating racial and ethnic disparities.
Unaddressed issues or concerns
This report fails to address many of the factors that cause the disparities and therefore require further attention in order to eliminate them. A 2003 article suggests that on all the assessed health outcomes, minority women were more likely than White women to have poor pregnancy outcomes and suggests cultural insensitivity, insufficient health literacy, and limits to health care access are important causes of racial disparities in maternal health outcomes (Anachebe S37).
Reference List
Anachebe, Ngozi F. and Madeline Y. Sutton. “Racial Disparities in Reproductive Health Outcomes.”American Journal of Obstetrics and Gynecology. 188.4 (2003): S37-42.
How to Access Report
http://www.gwhealthpolicy.org/downloads/GWU_Disparities_Report.pdf