Dr. Alberti is senior director, Health Equity Research and Policy, Association of American Medical Colleges, Washington, DC. Dr. Bonham is chief scientific officer, Association of American Medical Colleges, Washington, DC. Dr. Kirch is president and CEO, Association of American Medical Colleges, Washington, DC.
Acad Med. 2013 Nov;88(11):1619-23. doi: 10.1097/ACM.0b013e3182a7f76f.
Equity in health and health care in America continues to be a goal unmet. Certain demographic groups in the United States-including racial and ethnic minorities and individuals with lower socioeconomic status-have poorer health outcomes across a wide array of diseases, and have higher all-cause mortality. Yet despite growing understanding of how social-, structural-, and individual-level factors maintain and create inequities, solutions to reduce or eliminate them have been elusive. In this article, the authors envision how disparities-related provisions in the Affordable Care Act and other recent legislation could be linked with new value-based health care requirements and payment models to create incentives for narrowing health care disparities and move the nation toward equity.Specifically, the authors explore how recent legislative actions regarding payment reform, health information technology, community health needs assessments, and expanding health equity research could be woven together to build an evidence base for solutions to health care inequities. Although policy interventions at the clinical and payer levels alone will not eliminate disparities, given the significant role the social determinants of health play in the etiology and maintenance of inequity, such policies can allow the health care system to better identify and leverage community assets; provide high-quality, more equitable care; and demonstrate that equity is a value in health.
在美国,卫生公平和医疗公平仍然是一个尚未实现的目标。美国的某些人口群体——包括少数族裔和社会经济地位较低的个人——在多种疾病方面的健康结果较差,全因死亡率较高。尽管人们越来越了解社会、结构和个人层面的因素如何维持和造成不平等,但解决这些问题的办法却一直难以捉摸。在本文中,作者设想了《平价医疗法案》和其他最近立法中的与差异相关的规定如何与新的基于价值的医疗保健要求和支付模式联系起来,以激励缩小医疗保健差距,并使国家向公平方向发展。具体来说,作者探讨了最近关于支付改革、医疗信息技术、社区健康需求评估以及扩大健康公平研究的立法行动如何可以结合起来,为解决医疗保健不公平问题建立一个证据基础。尽管仅在临床和支付方层面采取政策干预措施并不能消除差异,但鉴于健康的社会决定因素在不平等的病因和维持中起着重要作用,此类政策可以使医疗保健系统更好地识别和利用社区资产;提供高质量、更公平的护理;并表明公平是健康的一个价值。