Conclusions

The full effects of the Massachusetts health reform plan on the reduction of racial and ethnic health disparities are still unknown. More measurements are needed and more data need to be collected. What is in place, however, is a step in the right direction:

  • The Massachusetts Health Disparities Council will release a yearly report card showing the ongoing results of the efforts of the state health care reform program to reduce disparities.
  • Mass Health Medicaid is revising and implementing financial incentives to reduce health disparities by race and ethnicity at the hospital level.
  • The Quality and Cost Council is poised to make Massachusetts the first state in the nation to stratify HEDIS (Healthcare Effectiveness Data and Information Set) quality measures by race and ethnicity.

DISCUSSION

One workshop participant described the tendency of people to assume that a community that has no local grocery stores is, by definition, a community of color. She questioned, then, why indirect estimation needs to be used to determine this when it is already assumed to be true.

Joel Weissman responded that in large cities, large differences exist between communities within that city; in other words, as he stated, “not all minority communities are the same.” The indirect estimation technique has the advantage of allowing more detailed information about a community to be collected. For example, one community may not have adequate bus service for its residents to access health care in a neighboring community. This means that the issues can be better defined and resources can be better targeted to reflect the population of that community.

REFERENCES

Beveridge, W. 1942. Social insurance and allied services. Presentation to the Parliament of the United Kingdom, November.

Fremont, A. M., A. Bierman, S. L. Wickstrom, C. E. Bird, M. Shah, J. J. Escarce, T. Horstman, and T. Rector. 2005. Use of geocoding in managed care settings to identify quality disparities. Health Affairs 24(2):516–526.

Massachusetts Division of Health Care Finance and Policy. 2008. 2008 Massachusetts Health Insurance Survey. Boston, MA: Author.

McWilliams, J. M., E. Meara, A. M. Zaslavsky, and J. Z. Ayanian. 2009. Differences in control of cardiovascular disease and diabetes by race, ethnicity, and education: U.S. trends from 1999 to 2006 and effects of Medicare coverage. Annals of Internal Medicine 150(8):505–515.



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