Unequal Treatment

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Ever since 2002, when the Institute of Medicine released its groundbreaking report, one of the top issues facing the medical community has been how to resolve health care disparities.

The IOM’s report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, revealed that wide differences exist between racial and ethnic minorities and whites in the quality of the care they receive, even when such factors as insurance, access to care, and ability to pay were comparable.

A dozen years after the report, the medical community is still confronting the issue.

In the April episode of Physician Focus, three physicians from the Massachusetts Medical discuss disparities in health care, how they affect the health of minorities, and what both physicians and patients can do to reduce these differences and improve care.

Featured guests are Ronald Dunlap, M.D., President of the Massachusetts Medical Society, and Milagos Abreu, M.D., M.P.H., Vice Chair of the MMS Committee on Diversity in Medicine and Founder and President of the Latino Health Insurance Program based in Framingham. Hosting this edition is Alice Coombs, M.D., a past president of MMS and a member of the American Medical Association’s Commission to End Health Care Disparities.

Because no two patients are alike, disparities in medicine affect all patients, and in any discussion of the topic, it’s important to distinguish between health disparities and health care disparities.

Health disparities are defined as the differences in the incidence of disease between genders or given groups. Heart disease, for example, affects men and women in different ways. Similarly, African Americans are known to have higher average blood pressure than whites. These are natural occurrences.

Health care disparities represent the differences in the care that’s delivered for a certain condition. Two people, for example, with the same disease at the same level of severity, would receive different levels of care, even when insurance, income, age, and medical conditions are comparable.

The conversation among the physicians touch on the many factors that contribute to disparities in care: a lack of knowledge on the part of patients, cultural differences and reduced communication between health providers and patients, the distribution [and lack] of providers within certain communities, and even the economics of the health care system and payment models.

The issue of health care disparities is a significant one, and as the demographics and populations change here in Massachusetts and across the U.S.A., it takes on increasing importance.

While disparities continue to affect the health and lives of patients so far after the IOM's report, the physicians believe that the problems are not insurmountable. All three agree that bridging the communication gap between provider and patient is critical to reducing disparities and that actions by both sides are needed.

I invite you to view the conversation and learn how physician and patient can work together to improve care for racial and ethnic minorities and reach the goal of equal treatment.

Photo: From left, Dr. Alice Coombs, Dr. Ronald Dunlap, and Dr. Milagros Abreu, on April's Physician Focus, discussing health care disparities.