Racial, ethnic disparities in health care: Knowing how to fight them

WASHINGTON – Dr. Anna Maria Izquierdo-Porrera knows firsthand that medical offices must be places on which patients can rely to receive quality health care when they need it and places to which they will want to return.

As medical director of the Spanish Catholic Center of Catholic Community Services in Washington, she tries to cultivate personal relationships with those in her care, such as the fiftysomething Cuban-born homeless man who became “part of the family” at the center until his recent death in hospice care after fighting both heart disease and lung cancer.

That man might have been homeless but he did have a “medical home,” according to the definition offered by the Commonwealth Fund in its new study on how racial and ethnic disparities in health care could be reduced or eliminated if more minority patients had a medical home.

“This survey shows that if you can provide both insurance and access to a true medical home, racial and ethnic differences in getting needed medical care are often eliminated,” said Dr. Anne Beal, senior program officer at the Commonwealth Fund and lead co-author of the study, during a June 27 news conference in Washington.

According to the report on the study, patients have a medical home if they meet four criteria: have a regular provider or place of care; report no difficulty contacting a provider by phone; report no difficulty getting advice or medical care on weekends or evenings; and find office visits well-organized and efficiently run.

Only 15 percent of Hispanics reported having a medical home, compared to 28 percent of whites, 34 percent of African-Americans and 26 percent of Asian-Americans. Overall about one in four U.S. adults met the criteria for having a medical home.

But when they did have a medical home, nearly three-quarters of adults – regardless of race – reported they can always get the care they need, compared with 52 percent of those with a regular provider but no medical home and 38 percent of those without a regular health provider.

The margin of error for the study was plus or minus 2.9 percentage points.
The Spanish Catholic Center, which provides medical, dental, immigration, legal, educational and social services to more than 40,000 people, has a clientele that is 95 percent Hispanic and 98 percent uninsured, said Izquierdo-Porrera.

“Coming to the doctor is a hard thing for them to do” because of work and other commitments, she said, so the center tries to make visits as easy as possible with evening and weekend hours and by offering prescription and laboratory services as well as medical care.

“From a practical point of view, we only accept patients that we can see on a regular basis,” she added. “We’re careful not to take more patients than we can care for.”

Izquierdo-Porrera said the center has had success in improving the health status of patients with chronic conditions like diabetes. “We’re above the national numbers for Medicare and Medicaid,” she said.

Another example of a medical home cited by the Commonwealth Fund is Washington Pediatric Associates, where children and their families can receive services ranging from lactation consultations to parenting classes to infant/toddler yoga and massage to immunizations and information about nutrition and early childhood education.

In a prenatal visit, families meet the physicians and other health care providers in a group setting to learn about the philosophy of the practice, ask questions and tour the examination rooms. The practice also places a special emphasis on pediatric literacy, with children between 6 months and 6 years receiving a new, age-appropriate book at every well-child visit.

At the recent Catholic Health Association assembly in Chicago, Catholic health care leaders participated in an ethics lab in which they assessed the prevalence of racial and ethnic disparities in their own institutions and discussed how to end them.

Using an electronic voting system, 29 percent of the leaders said racial and ethnic disparities occurred “frequently” in Catholic health care and 59 percent said they happened “sometimes.” Only 9 percent said they occurred “seldom” and 3 percent said they were “rare.”

“Catholic health care is not exempt from what has been going on in society,” said VeLois Bowers, senior vice president for diversity and inclusion at Trinity Health in Novi, Mich. Citing continued problems with discrimination in employment, education and other fields, she added, “We want to not believe it exists.”

“If we have any kind of disparities in health care it is wrong,” said Sister Shawnee M. Daniels-Sykes, a School Sister of Notre Dame who is an assistant professor of theology at Mount Mary College in Milwaukee. “When one part of the human family is hurting or challenged in any way we’re all affected.”

Dr. Jose Santiago, senior vice president and chief medical officer at Carondelet Health Network in Tucson, Ariz., said, “Nothing I’ve seen indicates that we in Catholic health care are immune.”

To combat racial and ethnic health disparities, “having Catholic values is an indispensable component,” Santiago added, “but it is not sufficient.”

He told a joke to illustrate his point: A rabbi is visiting a priest friend in Madrid, Spain, and they go to a boxing match. Before the fight, one boxer makes the sign of the cross and the rabbi asks, “What does that mean?” The priest replies, “Not very much unless he knows how to fight.”

Catholic Review

The Catholic Review is the official publication of the Archdiocese of Baltimore.