Social Equity: Health and Healthcare Indicators

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Social Equity Health and Healthcare Indicators

• Richard W. Hug
• Fifth Social Equity Leadership Conference
• Omaha, Nebraska
• February 2, 2006

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Outline

• Social Equity Defined
• Key Indicators
• Initiatives
• Resources
• Box / Eikenberry

• Dimensions (ADPQO)
• Access / Distribution
• Process
• Quality
• Outcomes

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Social Equity -- Defined

• Social equity is the fair, just and equitable
  management of all institutions serving the public
  directly or by contract. This includes the fair,
  just and equitable distribution of public service
  and the implementation of public policy and the
  commitment to promote fairness, justice, and
  equity in the formation of public policy.
  (Sounding the Call, p. 1)

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Social Equity Indicator Areas

• Access / Distribution -- a commitment to reduce
  omission and neglect that contribute to
  systematic inequality in access to services.
• Procedural Fairness a determination to
  eliminate acts of commission that deprive
  individuals of fair and consistent treatment and
  to act with urgency when members of groups are
  systematically treated unfairly.

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Indicator Areas (continued)

• Quality ensures that those who receive services
  and benefits are not slighted and consigned to a
  level of quality that does not measure up to
  acceptable standards
• Outcomes rejects systematic differences in life
  chances across groups in society promotes the
  idea of narrowing and eliminating disparities

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Indicators Access / Distribution

• Source The National Healthcare Disparities
  Reports (NHDR)
• Getting into the system
• Health Insurance
• Usual Source of care
• Utilization
• Summary Measures

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Exhibit 1 Health Insurance Coverage by
Ethnicity and Age, 2004
.
Source Rhoades, J.A. The Uninsured in
America, 2004 Estimates for the
Noninstitutionalized Population under Age 65.
Statistical Brief 83. June 2005, Agency for
Healthcare Research and Quality, Rockville, MD.
http//www.meps.ahrq.gov/papers/st83/stat83.pdf
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Exhibit 2 -- Selected indicators of the usual
source of care, by race / ethnicity, 2001
Source NHDR Tables 128, 129, and 131
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Exhibit 3 -- Selected indicators of the usual
source of care, by income, 2001
Source NHDR, Table 128, 129, and 131
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Exhibit 4 -- Selected Indicators of Utilization
of Health Care Services, by Racial / Ethnic
Group, 2001
Source NHDR Tables 65, 171, and 196
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Exhibit 5 -- NHDR Summary Measures of Access
Percent of the Access Measures (n31) for Which
the Groups Access was Worse than the Comparison
Group
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Indicators Procedural Equity

• Referrals to specialists
• Explanations of conditions
• Respect
• Waiting time

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Exhibit 6 -- Selected Procedural Equity
Indicators, by Ethnicity, 2001
Source NHDR Tables 144, 152
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Exhibit 7 -- Selected Procedural Equity Measures,
by Income, 2001
Source NHDR Tables 144, 152
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Exhibit 8 -- Selected Indicators of Procedural
Equity, by Ethnicity, 2001
Source NHDR Tables 146, 153, and 157
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Indicators -- Quality

• Disease Management
• Preventive Care
• Overall Satisfaction
• Summary Measures

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Exhibit 9 -- Selected Quality Indicators by race/
ethnicity, 2001
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Exhibit 10 -- Summary of Selected Quality
indicator disparities
Key -- difference blank no
difference Source NHDR Report
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Exhibit 11 -- Selected Quality Measures
2001
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Exhibit 12 -- NHDR Summary Measures of Quality
Percent of the Measures for Which the Groups
Quality of Care was Worse than the Comparison
Group
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Indicators Outcomes

• Mortality Rates
• Maternal and Infant
• Heart Disease
• Cancer

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Exhibit 13 -- Assorted infant and maternal
mortality rates, by race / ethnicity, 2001
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Exhibit 14 -- Mortality Rates for selected
diseases heart -- by race / ethnicity, 2001
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Exhibit 15 -- Selected Cancer Mortality Rates by
Race / Ethnicity, 2002
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Outcomes Some other Numbers

• 83,369 (2000) Satcher, 2005
• 25 -- 75
• 4 / 34

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Conclusion

• There are numerous, often large, health
  disparities in all the social equity measurement
  areas
• Access / Distribution
• Procedural Equity
• Quality
• Outcomes

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Things that I wont have time to talk about

• Initiatives
• Access --
• Procedural
• Quality
• Outcomes
• Resources
• Box paper
• Eikenberry paper

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Initiatives

• Access / Distribution
• SCHIP, CHC, 23-42
• Procedural equity
• OCR, LEP, CC
• Quality
• QIOs, QAPIs, IOM-NQCB
• Outcomes
• COP, HDCs

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Resources

• Access Distribution
• NHDR, Satcher Pamies, Health Affairs
• Procedural Equity
• DB Smith
• Quality
• NHQR, IOM reports
• Outcomes
• Williams and Jackson,

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Social Equity Health and Healthcare Indicators

• Richard W. Hug
• Fifth Social Equity Leadership Conference
• Omaha, Nebraska
• February 2, 2006