Exam 2 Part 3

Why do racial and ethnic disparities still persist in health care?

Because of bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare providers contributed to racial and ethnic disparities in health care

Is health care a weak or strong health determinant?

Weak

Nonexcludable

if the good is available to one actor to consume, then other actors cannot be prevented from consuming it as well.

What is implicit bias?

refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner -Uncontrollable, unintentionally

Racial disparities in health care are ___________.

pervasive

What are some examples of public goods? (10)

• Fire Fighting Services • National Defense Programs •Police •Public School System •Highway System •Mass Transit System •Clean Air •Clean Drinking Water • Parks •Immunizations

What is residential segregation associated with?

Lower access to medical care and lower quality of care is available

What are the nursing homes like in residential segregated areas?

Lower quality

Have most disparities changed for racial and ethnic groups over the years?

NO

What did Davidson recall the US health care system as?

"The sick care system"

What does the US health care system have? (9)

*Duplication *Overlap *Inadequacy *Inconsistency *Waste *Complexity *Inefficiency *Financial manipulation *Fragmentation

What makes the US health care system unique? (5)

*It's not a system *No universal health care financed by taxes *No entitlement *No other country operates like the U.S. *Critical issues related to cost, access and quality

What are the hospitals like in residential segregated areas?

*Lower quality care *Less training & access to clinical resources *Higher readmittance and operative mortality risks for Blacks, Hispanics, and Medicaid patients at worst hospitals

There is little or no what in the US Health Care System?

*Networking *Interrelated components *Standardization *Coordination *Cost containment as a whole *Planning, direction

What are the racial difference for diagnosis and treatment for Kidney Failure and Access to Kidney Transplantation?

-African Americans were nearly four times likely to develop end stage renal disease (ESRD) than whites. -Fewer blacks than whites undergo kidney transplantation and the rate of survival is lower among blacks than whites.

What are the racial difference for diagnosis and treatment for Mental Illness and Biases in Diagnosis?

-African-Americans are diagnosed accurately less often than white Americans when they are suffering from depression and seen in primary care, or when they are seen for psychiatric evaluation in an emergency room. -Studies have found that that ER physicians and psychiatrists (both groups who are mostly white) spent less time with their black patients -Blacks and Hispanics are significantly more likely than whites to report perceived discrimination on the part of the mental health provider

How does health care affect the overall population health?

-Health care only reaches a small minority of the population (ill, dying, and injured people) -Does not have a big impact on the population's life expectancy

What are the racial difference for diagnosis and treatment for Pain Administration and Medication Choice?

-Blacks and Hispanics twice as likely as whites to receive no pain medication when in the emergency room -Blacks and Hispanics are less often to receive an opioid medication than Whites

What are some examples of private goods? (3)

-Food -Clothes -Cars -Flowers **Limited quantities

Describe the situation that the primary care physicians faced who worked in highly segregated residential areas.

-Had lower incomes -Worked with constrained financial resources -Which results in: *Decreases in the quality of coordination of care the ability to spend adequate time with patients *The ability to obtain specialty care when needed.

What is the possible explanation for the racial differences in diagnosis and treatment?

-Implicit bias, negative perceptions of communication, and lack of a primary care physician likely create these obstacles to health equity -Root = Physician Behavior

What does the U.S. leads the world in?

-Medical technology -Medical training -Research Sophisticated institutions, products, & processes

What is the Affordable Care Act?

-Obamacare -law signed to ensure all Americans have access to affordable healthcare

About how many people in the US are uninsured?

1 in 10 people in the US

What are the three racial differences in health care?

1. Access to health care 2. Access to primary care 3. Health literacy

What are the two largest black/white disparities?

1. Children without routine care 2. Adults without immediate care for illness or surgery

What were the five racial differences in health care with diagnosis and treatment?

1. Ischemic Heart Disease (IHD) and Advanced Care 2. Lung Cancer, Surgery, and Survival 3. Kidney Failure and Access to Kidney Transplantation 4. Pain Administration and Medication Choice 5. Mental Illness and Biases in Diagnosis

What are the two key characteristics of a public good?

1. Nonexcludable 2. Nonrivalrous

What are the two largest Hispanic/Non-Hispanic disparities?

1. Uninsured population 2. Children without a routine care

When was the Affordable Care Act signed into law?

2010

Which group is more likely to live in an area with a shortage of primary care physicians?

African American and Latinos

What is the significance of the Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare report by the IOM in 2003?

An IOM analysis that analyzed more than 600 articles that addressed the racial and ethnic disparities in healthcare.

Who do these racial disparities exist?

Bias from health care providers. -They have a harder time making accurate diagnosis, worse at reading signals from minority patients. -Beliefs already held about the behavior of minorities (stereotypes) -Mistrust on the patients side and biases about the medical system (ex. Tuskegee)

What are the racial difference for diagnosis and treatment for Ischemic Heart Disease (IHD) and Advanced Care?

Blacks hospitalized for the same disease and covered by the same insurance received substantially lower rates of potentially lifesaving procedures (cardiac catherization coronary artery bypass graft and angioplasty)

(T/F) Many people in the US do get the health care services they need.

FALSE; Many people in the US DO NOT get the health care services they need.

Is the health care system really about health?

Health care systems cannot be equated with health because, for the most part, health care systems are dealing with a small segment of the population. -Health care interventions are not the best route for promoting health.

Nonrivalous

Means that when one person uses a good, it does not prevent others from using it

What were the findings of the Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare report by the IOM in 2003?

Minorities are less likely than whites to receive needed services -There are disparities in treatments and these disparities exist because of implicit bias

What is health literacy?

Refers to the skills necessary for an individual to participate in the health care system and maintain good health. -These skills include reading and writing, calculating numbers, communicating with health care professionals, and using health technology

(T/F) Minorities are 28 times more likely to have low access to primary care.

TRUE

What are the racial difference for diagnosis and treatment for Lung Cancer, Surgery, and Survival?

There is lower rate of surgery among black cancer patients that was principally responsible for the black/white difference in survival. -Blacks had a much lower survival rate compared to whites

What differences in treatment exist for black people?

Treatment: •Cardiovascular procedures •Cancer diagnosis and treatment •HIV care •Diabetes •Kidney disease •Mental health problems •Pain medication --black patients less likely to receive pain meds compared to white patients regardless of SES

What were the findings of the 2017 HRQ report?

While some disparities have gotten better, many disparities remained

What is a public good?

a commodity or service that is provided without profit to all members of a society, either by the government or a private individual or organization.

Did a health gap still exist after the ACA was established?

YES

Agency for Healthcare Research and Quality (AHRQ)

a federal agency established to improve the quality, safety, efficiency, and effectiveness of health care for Americans

What is a private good?

a good or service whose consumption by one person excludes consumption by others -Rivalrous and Excludable