The quality of medical care and access to treatment have recently worsened for Hispanic and low-income patients, a sweeping federal report found. The National Healthcare Disparities Report, a snapshot of the nation's successes and failures in narrowing gaps between the healthcare of minority and white patients, shows there's been some progress, though.
Black patients saw 23 of 40 persistent disparities shrink in recent years. For example, differences in breast cancer screening between black and white women disappeared from 2000 to 2003. The report found access to care improved across the board for black, Asian, American Indian and Alaskan Native patients. The report tracked changes from the late 1990s to the early 2000s.
But other disparities lingered or worsened. Black patients were 10 times more likely than whites to be diagnosed with AIDS in 2003. American Indians and Alaskan Natives were even less likely to receive effective, proven treatment for a heart attack in 2003 than a year earlier. And Hispanic patients saw roughly 60% of persistent quality disparities worsen compared with the quality of care for non-Hispanic whites, including treatment for heart attacks, mental health, diabetes and children's access to dentists.
Access to care also worsened significantly for Hispanic and low-income patients. "It's getting tremendously worse," said Elena Rios, president and chief executive officer of the National Hispanic Medical Association. "Hispanics aren't getting adequate medical care," she said. "They're not accessing it. It's not available to them."
Hispanics saw disparities in five of six measures of access-including insurance coverage-worsen in recent years, the survey found. Low income levels and insurance coverage factor into the poorer care and access for Hispanics, Rios said, but so do language and cultural barriers that hinder communication and education. Hispanic children and adults struggle to communicate with providers, the report said.
"Things are moving in the right direction," though the gains aren't universal, said Carolyn Clancy, director of the HHS' Agency for Healthcare Research and Quality, which produced the report. "For Hispanics, that is not the case," she said.
The lack of Hispanic doctors, nurses and other health professionals aggravates cultural differences, said Rios, who criticized recent cuts to two federally funded programs for recruiting minorities into healthcare. The 2004 Sullivan Commission on Diversity in the Healthcare Workforce reported Hispanics make up 3.3% of U.S. physicians and 2% of U.S. nurses.
One system has had success in minority hiring. At Denver Health, 35% of primary-care providers, pediatricians, internal medicine and family physicians are minorities. Denver Health CEO Patricia Gabow said the safety-net provider's reputation for successfully working with underserved minority and low-income patients attracts diverse candidates. Seventy percent of Denver Health patients are minorities, she said, and 57% are Hispanic.
Despite chronic national disparities, Denver Health has erased-or reversed-gaps between minority and white patients. In a survey of regular patients, or those who visited a doctor three times in two years, 74% of white women received cervical cancer screening compared with 81% of black women and 88% of Hispanic women, Gabow said. Blood pressure and breast cancer screening among black and Hispanic Denver Health patients exceeds national averages for all patients.