Social, Moral

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Social, Moral Legal Obligations of Culturally
Competent Diabetes ProvidersSeptember 14, 2005

• John Molina, M.D.
• Medical Director
• Arizona Health Care Cost Containment System

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Diabetes is an Epidemic

• 6.5 of American Adults (5.5 in 2001)
• 12 Million dx with DM
• 5 Million undiagnosed
• Health U.S. 2003, CDC, National Center for Health
  Statistics

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Minority GroupsProportion of U.S. Population

• 1970 16
• 1998 27
• 2050 50
• Source U.S. Census Bureau

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Racial/Ethnic Disparities

• Racial and ethnic minorities
• Higher rates of disease, disability, and death
• Receive lower quality health care
• Disparities persist after controlling for
  access-related factors, such as insurance status
  and income
• Institute of Medicine. Unequal Treatment
  confronting racial and ethnic disparities in
  health care. 2002

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Why Cultural Competency in Diabetes

• Demographic changes in population
• Health care disparities
• High cost of disease management
• 132 Billion
• 192 Billion over next 15 years
• Hogan, Nichols, Blauber, Bakst. Economic costs of
  diabetes in the US in 2002. Diabetes Care.
  200326917-932

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What is cultural competency?

• In clinical practice, cultural competence
  implies ability by health care providers and
  planners to understand and respond effectively to
  the cultural and linguistic needs of patients in
  the health care setting.
• http//www.betterdiabetescare.nih.gov/ISSUEScultur
  alcompetency.htm

Respect is really the essence of cultural
competency
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Social, Moral and Legal Obligations for cultural
competency

• What is fair?
• What is right?
• What is mandated?

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Social ObligationsWhat is fair?

• Social Justice
• What is due and owed
• Distributive Justice
• Equity of care
• Similar treatment of similars

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Moral ObligationWhat is right?

• Relating to the conscience or principle of right
  conduct
• Beneficence Hippocratic Oath
• Compassion
• Act in the patients interest
• Utilitarian Principle
• The most good for the most people (affected)

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Legal ObligationsWhat is mandated?

• No constitutional right to healthcare
• A right to healthcare can only be derived from
  bioethical principals
• Title VI of the Civil Rights Act of 1964
• Discrimination
• Tort Law (Medical Malpractice)
• -Informed consent

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Summary

• The social, moral and legal obligations for
  providing culturally competent healthcare serves
  as the basis for addressing racial and ethnic
  health care disparities

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Questions/Comments?