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当下时机已至:解决劳动力中的健康不平等问题。

The time is now: Addressing health inequities in the workforce.

作者信息

Sherman Bruce W, Sils Brian, Westrich Kimberly

机构信息

Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH.

Department of Public Health Education, School of Health and Human Sciences, University of North Carolina Greensboro.

出版信息

J Manag Care Spec Pharm. 2025 Apr;31(4):421-427. doi: 10.18553/jmcp.2025.31.4.421.

Abstract

As a major provider of health insurance for working-age Americans, employers can play a significant role in improving the health equity of their employees and family members. In this commentary, we describe how different stakeholders, including employers, their employees, clinicians, and health systems and health plans, each contribute to the observed inequities. Other systems-level factors, including racism, implicit bias, medical mistrust, health literacy limitations, and health care access and affordability concerns have been also shown to contribute to inequitable outcomes. Opportunities exist for employers to improve health equity among their benefits-enrolled employees and family members using data-driven approaches to ensure that benefits are more equitable in scope, access, and affordability. As an illustrative example of employer strategic considerations, we describe opportunities to identify and address inequities in prescription medication use. Additionally, employers can, and perhaps should, advocate for transparency in community-based health system and health plan reporting regarding health inequities and progress toward more equitable health care utilization and outcomes. Employers can also advocate for the delivery of more patient-centered, systems-based solutions, such as enhanced primary care and/or worksite clinics, and give consideration to establishing health equity performance-based incentives in their health care contracting. Further research in the employer setting can help to expand the adoption of a best-practices approach to achieving more equitable health outcomes.

摘要

作为美国劳动年龄人口医疗保险的主要提供者,雇主在改善其员工及其家庭成员的健康公平性方面可以发挥重要作用。在这篇评论中,我们描述了包括雇主、其员工、临床医生、医疗系统和健康计划在内的不同利益相关者是如何导致观察到的不公平现象的。其他系统层面的因素,包括种族主义、隐性偏见、医疗不信任、健康素养限制以及医疗保健可及性和可负担性问题,也被证明会导致不公平的结果。雇主有机会利用数据驱动的方法来改善其参保员工及其家庭成员的健康公平性,以确保福利在范围、可及性和可负担性方面更加公平。作为雇主战略考量的一个示例,我们描述了识别和解决处方药使用不公平问题的机会。此外,雇主能够而且或许应该倡导社区医疗系统和健康计划在健康不公平以及实现更公平的医疗保健利用和结果方面的进展情况进行透明报告。雇主还可以倡导提供更多以患者为中心、基于系统的解决方案,如强化初级保健和/或工作场所诊所,并考虑在其医疗保健合同中设立基于健康公平绩效的激励措施。在雇主层面的进一步研究有助于推广采用最佳实践方法以实现更公平的健康结果。

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Tackling Implicit Bias in Health Care.应对医疗保健中的隐性偏见。
N Engl J Med. 2022 Jul 14;387(2):105-107. doi: 10.1056/NEJMp2201180. Epub 2022 Jul 9.

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