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Universal
Coverage may narrow Racial, Ethnic and
Socioeconomic Gaps in Health Care
Newswise — Health care disparities in the
U.S. have long been noted, with particular
attention paid to the gaps separating racial
and economic groups.
And while some research has looked at how
insurance—and lack of insurance—contributes
to this imbalance, few, if any, studies have
quantified the impact of universal coverage
on differences in health outcomes between
these groups.
Now, by analyzing survey data describing
measures of blood pressure, cholesterol and
blood sugar collected between 1999 and 2006
from the National Health and Nutrition
Examination Survey (NHANES), a team of
researchers in Harvard Medical School’s
department of health care policy has
compared the health outcomes of individuals
by race, ethnicity and education.
What’s more, the researchers studied whether
overall discrepancies between these
demographic groups were narrowed among
adults with Medicare coverage after age 65.
Looking at data for more than 6,000
individuals between the ages of 40 and 85,
researchers probed important indicators of
disease control for hypertension, diabetes
and coronary heart disease.
They found that while health indicators
improved for all groups between 1999 and
2006, the socio-demographic gaps remained
unchanged or, in some cases, widened.
However, among individuals age 65 and older
who were eligible for Medicare, a U.S.
government-administered social insurance
program, the gaps narrowed substantially.
These findings are reported in the April 21
issue of the Annals of Internal Medicine and
are funded by The Commonwealth Fund, a
private foundation supporting independent
research on health policy reform and a high
performance health system.
“The tide is rising and it is lifting all
boats, but many are still left behind,” says
lead author J. Michael McWilliams, HMS
assistant professor of health care policy
and an associate physician in the Division
of General Medicine at Brigham and Women’s
Hospital.
“In addition to current quality improvement
efforts, we will likely need universal
coverage to achieve good control for all
adults with these conditions.”
The researchers noted that controlling blood
pressure, cholesterol and blood sugar are
critical steps to preventing devastating
complications of cardiovascular disease and
diabetes, such as heart attacks, strokes,
kidney disease and premature death.
These disease control measures were provided
by NHANES, a research program of the
National Center for Health Statistics, where
clinicians travel to all regions of the
United States to examine and provide
on-the-spot health evaluations for
individuals. All data from this program are
publicly available.
The researchers discovered a number of
examples where racial, ethnic and
socioeconomic gaps closed once individuals
were eligible for Medicare. For example:
• For systolic blood pressure, racial
disparities decreased by 60 percent
• For diabetes risk factors, educational
disparities decreased by 83 percent, while
racial and ethnic disparities fell by 78
percent
• For total cholesterol levels, educational
disparities disappeared altogether
“We found some important indicators that
universal health insurance may reduce
persistent disparities we’ve seen for far
too long in Americans from different racial
or ethnic groups,” says senior author John
Ayanian, professor of medicine and health
care policy at Harvard Medical School and
Brigham and Women’s Hospital and a professor
of health policy and management at the
Harvard School of Public Health.
“The results of this study make it clear
that guaranteeing access to affordable
insurance for all Americans is the essential
first step toward a high performing health
care system and a healthier America,” said
Commonwealth Fund President Karen Davis.
“As our leaders look toward health reform it
is critical that they take into account the
value of health care coverage for everyone
and assure that all Americans have the
ability to obtain insurance for themselves
and their families.”
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