Despite widespread public perception that the federal government and the private sector collect vast amounts of data, the availability of racial and ethnic data in the health care system itself is quite limited. A variety of government sources include data on race and ethnicity, but the utility of these data is constrained by ongoing problems with reliability, completeness, and lack of comparability across data sources. With only a few exceptions, private insurers and health plans do not maintain data on the race or ethnicity of their enrollees.

In this paper, we provide a framework for describing the role of racial and ethnic data in supporting essential functions of the health system. We first illustrate the value of racial ethnic data collection by describing ways such information can be used to reduce disparities, particularly with respect to the quality of care. We describe how data on primary language and socioeconomic status can complement racial and ethnic information. We then assess current sources of racial and ethnic information and the challenges inherent in collecting it. We conclude with a series of recommendations for enhancing the availability and use of data in the public and private sectors.

Throughout our discussion, we emphasize the federal role in data collection. However, since only about half of the minority population in the United States receives care in a public-sector system (e.g., Medicare, Medicaid, Department of Veterans Affairs, Department of Defense), the importance of private-sector and other government efforts should not be overlooked. Nevertheless, successful fulfillment of the federal role will be essential to facilitate state, local, and private-sector initiatives in public health, service delivery, and research.

THE CHALLENGE OF IDENTIFYING HEALTH DISPARITIES

The United States is becoming increasingly diverse. White Americans currently constitute nearly 70 percent of the population. However, by 2050, persons of color will make up nearly half of the population. In some states, such as California, this transition has already occurred, and the proportion of California’s population that is Hispanic is expected to grow dramatically in the next decade. Asian/Pacific Islanders still constitute only a small proportion of the U.S. population, but they currently have the largest rate of population growth (U.S. Bureau of the Census, 1990). These demographic shifts have profound implications for health and health care in this country because minority populations experience a disproportionate burden of health problems.

Overall, African Americans continue to have some of the worst health outcomes. However, discussion of health disparities among racial and ethnic minorities must move well beyond comparisons of African Americans



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