By identifying places in the health care system
where people are disadvantaged, we can identify ways to deliver better care.
The wealthiest Americans can expect to live more than six years longer than their poor counterparts. African Americans have higher rates of diabetes, hypertension, and heart disease than other groups. Adults with serious mental illness die 25 years earlier than other Americans. Disparities in health, such as these, are persistent and in some cases widening.
Health disparities refer to differences in the health status of certain groups of people caused by social, economic, and environmental disadvantage. Disadvantaged groups can include: minorities, poor, elderly, chronically ill, disabled, and the unemployed. These groups are often medically underserved—with less access to care, less insurance coverage, higher rates of illness, and, ultimately, worse health outcomes.
This is a problem not only for the individuals who don’t get the care they deserve, but also results in significant costs to the health system. Today, nearly half of the total health care expenses in America are spent on only five percent of the population. A health system that is better tailored to the needs of disadvantaged populations will result in better health and wiser spending.
Researchers at The Dartmouth Institute are working to understand how disadvantaged groups are being impacted by the health system so we can identify solutions to reduce costs and improve care.
What are the patterns of health care use, spending, and outcomes for specific groups like low-income, elderly, or chronically ill patients?
For elderly populations, for example, we examine the factors driving high spending and determine how well the system understands the goals of elderly patients and responds to those goals.
To get a fuller picture of the factors impacting care delivery to disadvantaged groups, we also consider external influences, like the impact of changes in insurance coverage or state and national policy changes. We have found, for example, that state laws have no impact on prescribing opioids for disabled adults. We have found that Accountable Care Organizations (ACOs)—a new model of payment and care delivery—were less likely to form in areas with more minority and poor residents, and that ACOs with higher minority patients were performing worse on quality outcomes. By identifying these places in the health care system where people are particularly disadvantaged, we can identify ways to reduce wasted spending and deliver better care to everyone.