Employer concern is rising over racial and ethnic disparities in health care
Like many Americans, business leaders consider achieving health and health care equity a moral imperative.
Dramatic disparities in health care and health outcomes for people of color in America compared to the broader population are nothing new. They’ve been documented for decades and are the result of persistent systemic and structural inequities that impact the daily lives of Black, Asian, Latinx and indigenous Americans. Now, fueled by U.S. Census data that show racial and ethnic groups will make up half of the U.S. population by 2045, addressing these disparities is becoming a priority for a growing number of U.S. employers. Without action, these disparities are only going to get worse.
Related: ACA cut racial disparity in health care coverage… for a while
As the CEO of a cooperative of large U.S. employers working together to provide high-quality health care to their employees, retirees and their families, I can tell you that employers are concerned. Like many Americans, business leaders consider achieving health and health care equity a moral imperative—the right thing to do. Plus, there is a second motivator that cannot be overlooked: health disparities are expensive… and someone has to pay the bill. Often, that burden falls to employers.
About 158 million Americans get health insurance through their employers. This is just under half of the total U.S. population and more than three and a half times the number served by Medicare, the second-largest source of U.S. health care coverage.
The moral imperative
It is well documented that people of color suffer and die from treatable illnesses more often than white people. Men and women of color have higher rates of diabetes and hypertension. They die more often from various types of cancers. Women of color have a much higher risk of death from pregnancy complications and infant mortality rates are higher. Children of color have higher death rates from asthma. Further, research shows that crises such as the COVID-19 pandemic, the 2008 Great Recession and natural disasters caused by extreme climate events exacerbate health inequities, as they disproportionately affect people and communities of color.
There are lots of reasons for these disparities. One is a lack of knowledge among some providers of racial and ethnic differences in risk factors for various illnesses and the effects of various prescription drugs. Others are language and cultural barriers and lower levels of health literacy that keep people of color from seeking medical care.
However, too often the cause is more explicit: discrimination based on provider biases and racism. The results of a national survey of 2,137 people 21 years or older commissioned by the University of Michigan School of Public Health, conducted in May 2019 by the National Opinion Research Center, brought the magnitude of the problem into sharper focus. The survey found that 1 in 5 U.S. adults has experienced discrimination in our health care system, with racial or ethnic discrimination the most common type. Of those, 72% have experienced it more than once. The survey also showed that income levels play a role in discrimination, with lower-income people experiencing it more often.
It should be noted that no person of color is immune from discrimination in our health care system. Tennis great Serena Williams tells a harrowing story of being in the hospital after giving birth via C-section and suddenly feeling short of breath. Williams has a history of blood clots and had discontinued her anticoagulant regimen due to the surgery. So, she suspected she was having another pulmonary embolism. She alerted a nurse and asked for a CT scan. The nurse dismissed her concerns as confusion caused by her pain medication. Williams persisted until a doctor was called. An ultrasound was performed on her legs and when nothing showed up, a CT scan was ordered—the very test that Williams knew she likely needed from the outset. The scan showed small blood clots in her lungs that were fortunately treated successfully.
The question must be asked. Why were the symptoms and medical history of one of the world’s greatest athletes—a woman trained to notice the smallest changes in her body, let alone the frightening symptoms of a pulmonary embolism—at first dismissed by health providers? It is hard to know for sure. But studies show that health providers often don’t listen to new mothers and that African American women are the least likely to be listened to.
The economic imperative
The moral imperative of eradicating health disparities is clear. But the high cost of these disparities also cannot be ignored. They result in approximately $93 billion in unnecessary medical care costs and $42 billion in lost productivity every year, according to research by Altarum, a nonprofit that works with federal and state health agencies and foundations to improve health outcomes of Medicare and Medicaid beneficiaries. Premature deaths also result in additional economic losses.
As racial and ethnic groups increase as a percentage of the U.S. population, economic costs and losses will continue to grow. Employers are better positioned than most to know that resolving health disparities is essential for not only improving the health and well-being of their employees, but also for improving our country’s overall economic prosperity and the prospects of the companies they run.
A source of optimism in the current bleak picture of health inequities is that most of its causes are avoidable if people and institutions have the will to act. Motivated by both moral and economic imperatives, U.S. employers believe they can make a difference by joining forces, sharing best practices and aggregating actionable data that exposes the disparities between people of color and white people.
There is no one strategy for eliminating health disparities in our health care system. But there should be one purpose we pursue together: equal respect and compassion for every person in our health care system. Each of us can play a role in reaching that compelling aspiration.
In Part Two, I will explore what employers can and are doing to tackle racial and ethnic disparities in health care. These include leveraging the power of collective action, expanding the number of people who have health coverage, improving access to quality care and aggregating data that exposes racial and ethnic health disparities so they can be identified and addressed.
We have work to do.
Robert Andrews is chief executive officer of the Health Transformation Alliance (HTA), a cooperative America’s leading employers that have come together to fix our broken health care system. Prior to the HTA, he served as a Member of the United States House of Representatives for nearly 24 years.
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