!V. ,. 6 mottC35 MASSACHUSETTS GENERAL COURT I J OINT COMMITTEE ON HEALTH CARE UMASS/AMHERST _ 31S0bb DEfil E^fiD D ■pw1* *^H Wjt '.;.; m SB£ ' 1 HBPK*^ ■i •'■ ^ J****^SLI ft '^ J^Bi ^H IB^uc-y^dfll^l - "H ^B". \IT DOCU COLLECTION JAN 2 * 2003 University of Massachusetts COMMITTEE BRIEFING PACKET Deposrtory Copy Including Testimony and Material submitted Post-Hearing Confronting Inequality: Disparities in the Provision of H ealth Care Among Racial, Ethnic and Geographic Populations A Special Oversight Hearing of the Joint Committee on Health Care Hearing Date: June 4, 2002 Updated with Submitted Material: June 27, 2002 State House, Boston Senator Richard T. Moore, Senate Chairman Representative Harriett L. Stanley, House Chairman Confronting Inequality A Special Oversight Hearing of t he Joint Committee on Health Care Table of Contents I. Introduction n. Selected Articles and Essays 1. Abstract and Executive Summary of Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care 2. Prejudice, Clinical Uncertainty and Stereotyping as a Source of H ealth Disparities. Ana I. Balsa, Thomas G. McGuire, July 20, 2001 3. Boston Globe article, Why Isn 't H ealth Care Colorblind? 3/26/02 4. Race/Ethnicity and Cancer Survival, the Elusive target of Biological Differences, Catarina I. Kiefe, PhD, MD. JAMA, April 24, 2002— Vol. 287, No. 16 5. Survival of Blacks and Whites after a Cancer Diagnosis, Peter B. Bach, MD, et al, JAMA, April 24, 2002— Vol. 287, No. 16 6. New York Times article, Racial Gap in Cancer Survival is not Biological, Study Finds, April 24, 2002 7. Addressing Racial and Ethnic Barriers to Effective Health Care: The Need for Better Data. Arlene Bierman, et al. Health Affairs, Vol. 21, No. 13, May /June 2002 8. Racial Disparities in Clinical Trials, Talmadge E. King, Jr. M.D. N. Engl. J. Med, Vol. 346, No. 1 8— May 2, 2002 IQ. List of Invited Speakers Commissioner Howard Koh, MD, Department of Public Health Commissioner Wendy Warring, Division of Medical Assistance Charles A. Welch MD, Massachusetts Medical Society, President Robert Gibbons, Massachusetts Hospital Association, Julie Pinkham, Executive Director, MNA Massachusetts Nurses Association. Prof. Thomas McGuire, Ph.D. Professor of Health Economics, Harvard Medical School Joseph R. Betancourt, MD, MPH, Senior Scientist, Institute for Health Policy, Director for Multicultural Education, Massachusetts General Hospital-Harvard Medical School Giselle Thornhill, MD, MPH, Director of Clinical Health Affairs, Mass League of Community Health Centers John Rich, MD, Medical Director, Boston Public Health Commission IV. Testimony and Other Material Submitted Post-Hearing 1 . Testimony of Wendy Warring, Commissioner, Department of Medical Assistance 2. Journal Articles Submitted in conjunction with the testimony of Charles A. Welch, MD, President, Massachusetts Medical Society 3. Testimony of Joseph R. Betancourt, MD, MPH 4. Testimony of Gisele Thornhill, MD, MPH 5. Testimony and statistical material from John A. Rich, MD, MPH and an article from the American Journal of Public Health, Levels of R acism: A Theoretic Framework and a Gardener 's Tale 6. The Middlesex County Alumnae Chapter of Delta Sigma Theta, submitted a copy of a resolution adopted by the Chapter. The resolution calls for the support of health and wellness programs for the African American community. Confronting Inequality A Special Oversight Hearing of t he Joint Committee on Health Care Introduction In M arch of 2002 the National Academy of Science's Institute of Medicine released a pre-publication report titled, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. The report's conclusion: "racial and ethnic minorities tend to receive lower-quality health care than whites do, even when insurance status, income, age and severity of conditions are comparable" is, sadly, not considered surprising among health care researchers who have examined the issue. Nor is this conclusion surprising for a consistent reader of the Health/Science section of any of the Countries' major newspapers or magazines; for several years now studies reporting the particulars of disparate health care treatment have been reported by news organizations, medical journals and other publications. Despite the attention the issue intermittently receives however, a comprehensive public policy response involving the government, the private health care sector and health care researchers has not been explored. It is the Committee's hope that this oversight hearing will reveal several policy ideas — short term and long-term — that can be pursued by all constituencies working in conceit. The publication of Unequal Treatment is the result of a request from the U.S. Congress for a study by the Institute of Medicine that would reveal the extent of the health disparities and propose possible solutions. Actual publication of the full report will not occur until the end of June 2002 but the report and the executive summary are available online at the Institute of Medicine's website, www.iom.edu. The executive summary of Unequal Treatment is included in this briefing packet. However, one paragraph of the executive summary should be noted because it is a startling recitation of the extent of the problem. On page 3 of the summary the authors' write: A large body of published research reveals that racial and ethnic minorities experience a lower quality of health services, and are less likely to receive even routine medical procedures than are white Americans. Relative to whites, African Americans - and in some cases, Hispanics - are less likely to receive appropriate cardiac medication (e.g., Herholz et al., 1996) or to undergo coronary artery bypass surgery (e.g., Ayanian et. Al, 1993, Hannan et al, 1999; Johnson et al, 1993; Peterson et al., 2002), are less likely to receive hemodialysis and kidney transplantation (e.g., Epstein et al., 2000; Barker-Cummings et al., 1995; Gaylin et al, 1993), and are likely to receive a lower quality of basic clinical services (Ayanian et al., 1999) such as intensive care (Williams et al., 1995), even when variations in Digitized by the Internet Archive in 2013 http://archive.org/details/confrontinginequOOmass such factors as insurance status, income, age, co-morbid conditions, and symptom expression are taken into account. Significantly, these differences are associated with greater mortality among African- American patients (Peterson et al., 1997; Bach etal., 1999) And research also suggests that disparate access to quality health care is not only associated with minority status; geographic location may also be an indicator of the level of care a patient receives. For example, a study by the Department of Public Health found that the rate of birth defects varies by region of the state, with the western region of the state experiencing a slightly higher rate of birth defects. Within the literature included in this packet, the two most common suggestions for reducing the impact of race, ethnicity and location on health care outcomes are the increased collection of data to better target the problem and additional training of medical students to ensure that they are able to discern any bias or harmful preconceptions in their diagnoses or recommendations of treatment. These two proposals, data collection and cultural competence training, should, at a minimum, constitute the beginning of a response and it is the Committee's hope that this hearing will reveal additional solutions as well.