Disparities in health care

You should know

• Studies show that racial and ethnic minorities receive lower-quality health care than non-minorities, even when insurance status, income, age and severity of conditions are comparable.¹ 
• About 84,000 deaths occur in the United States each year due to the health care gap that separates minorities from non-minorities.² 
• Private and public sectors are working in concert on initiatives aimed at reducing disparities. Aetna took a leadership position in 2001 when we launched an enterprise-wide initiative to reduce racial and ethnic disparities and improve access to quality health care services for our members.

Background 

Health care disparities, including unequal health care access and outcomes, are a critical challenge to the American health care system.

• African American males are 1.4 times more likely, and African American females are 1.2 times more likely, to die of cancer than their white counterparts.³
• African American and Latina women who get breast cancer are more likely to be diagnosed at a later stage of the disease than white women.⁴ Only 38 percent of Latina women age 40+ have regular screening mammograms.⁵
• African American women have consistently higher rates of premature births than do white women.⁶
• African Americans are 1.6 times more likely, and Hispanic/Latino Americans are 1.5 times more likely, to have diabetes than whites of similar age.⁷

The Aetna difference 

Aetna has taken a multidimensional approach to addressing health care disparities through a variety of prevention and educational initiatives. Through careful evaluation of the results, Aetna is also advancing the knowledge of others by sharing our experience.

Key to our efforts is the voluntary provision of self-identified race, ethnicity and language preference data by our members. As of April 1, 2007, more than 5.2 million members have provided this data. Aetna has implemented culturally appropriate disease management methods targeting our members with diabetes. For instance, Aetna's blood glucose monitoring program uses Spanish language services and materials to better serve and empower Spanish-speaking members with diabetes.  Aetna has created training programs and seminars to educate employees on the topic of cultural competency - more than 95 percent of our clinical staff have completed the training.  As part of Aetna's Beginning RightSM maternity program, we offer services that help prevent preterm labor for African American women through education and case management.  Through the Aetna Foundation, Aetna also has committed more than $15 million since 2001 to support programs that address racial and ethnic disparities in health care.

Results 

The problem of disparities will not be solved overnight, but Aetna's initiatives are already producing results. For example:

The yearly mammography screening rate has doubled for African American and Hispanic members since Aetna's Breast Health outreach reminder program began.  Among self-identified African American women enrolled in the Beginning Right maternity program, those who accepted preterm labor education and prevention services tended to have more full-term deliveries than those who declined these services. 

Questions & answers: 

Q.  Why should employers be concerned about addressing the health care needs of a diverse workforce?
A.  The face of America's workforce is changing rapidly as our nation's population of ethnic and racial minorities continues to grow. Providing employees of all racial and ethnic backgrounds with access to quality health care benefits and resources can help them stay healthy. Employers, in turn, will benefit from increased productivity, lower absenteeism and, possibly, lower health care cost increases.

Q.  How does Aetna use the data it collects on race, ethnicity and language?
A.  Aetna uses information our members voluntarily provide to:

• Develop preventive health, early detection and disease management programs and processes.
• Assess Aetna's health care provider networks' ability to meet race, ethnicity, culture and language communication needs and preferences of our member population.
• Create and deliver quality improvement, management or assessment programs and processes.
• Measure the performance and outcomes of our programs and processes.
• Help gain accreditation by the National Committee for Quality Assurance (NCQA) and other accreditation organizations.
• Satisfy state and federal requirements.

Q.  Does Aetna have a confidentiality policy concerning race, ethnicity and language?
A.  Yes. Aetna has developed strict policies and procedures to protect member information -- including race, ethnicity and language preference information -- against inappropriate use and disclosure. Information that can be linked to an individual member may be used only for the purposes listed above.

Q.  What will it take to close the racial and ethnic divide in health care quality?
A.  The issue of health care disparities is immensely complex, but there are targeted solutions that can help us bridge the gap. Emphasis must be placed on encouraging healthy lifestyles, timely screenings, accessible medication and regular care. Language and cultural barriers must be eliminated. At the very least, patients must be given tools that help them to speak more confidently and effectively with their health care providers so that they can take greater control of their health and well-being.

¹ Unequal Treatment - Confronting Racial and Ethnic Disparities in Healthcare, Institute of Medicine, 2003.
² Satcher, D., et al., "Trends: What if We Were Equal? A Comparison of the Black-White Mortality Gap in 1960 and 2000," Health Affairs, March/April, 2005.
³ African-American to White Cancer Mortality Rate Ratios, US, 1997-2001, National Center for Health Statistics, Centers for Disease Control and Prevention.
⁴ American Cancer Society, www.americancancersociety.com, 2003.
⁵ The National Hispanic Leadership Initiative on Cancer: En Accion, Preventing Cancer in Hispanics, 1998.
⁶ Ventura S.J., et al., Final data for 1999 National Vital Statistics Report, 2001.
⁷ National Diabetes Fact Sheet, American Diabetes Association, 2005.