Martin Luther King, Jr'

1
Martin Luther King, Jr.

• "Of all the forms of inequality,
• Injustice in health care is
• the most shocking
• and inhumane."

2
National Scorecard, 2008 Chartpack

• This Chartpack presents data for all indicators
  scoredin the National Scorecard on U.S. Health
  System Performance, 2008. Charts display average
  performance for the U.S. as a whole and the range
  of performance found within the U.S or compared
  with other countries.
• The charts accompany the Commissions July 2008
  report, Why Not the Best? Results from a National
  Scorecard on U.S. Health System Performance, 2008.

3
Infant Mortality
EQUITY LONG, HEALTHY PRODUCTIVE LIVES
Infant deaths per 1,000 live births
By Mothers Education and Race/Ethnicity, 2004
By Race/Ethnicity, 19952004
Denotes baseline year. PIPacific Islander
AI/ANAmerican Indian or Alaskan Native. Data
National Vital Statistics System, Linked Birth
and Infant Death Data (AHRQ 2007b, Mathews 2007).
4
Coronary Heart Disease and Diabetes-Related
Mortality,by Race/Ethnicity and Education Level,
2004
EQUITY LONG, HEALTHY PRODUCTIVE LIVES
Age-adjusted per 100,000 population
Diabetes-Related Mortality
Coronary Heart Disease Mortality
Note Data by education level based on total of
36 reporting states and D.C. for people ages
2564. Data National Vital Statistics
SystemMortality (Retrieved from DATA2010 at
http//wonder.cdc.gov/data2010).
5
EQUITY EFFECTIVE CARE
Untreated Dental Caries, by Age,
Race/Ethnicity,and Income, 20012004
Percent of persons with untreated dental caries
Children ages 619
Adults ages 2064
Adults ages 6574
Data Race/ethnicityNational Health and
Nutrition Examination Survey (NCHS 2007) Total
and incomeJ. M. McWilliams, Harvard Medical
School analysis of National Health and Nutrition
Examination Survey.
5
6
Waiting Time to See Doctor When Sick, by
Race/Ethnicity,Income, and Insurance Status, 2007
EQUITY PATIENT-CENTERED, TIMELY CARE
Percent of adults ages 1864 who reported waiting
six or more days for an appointment when sick or
needed medical attention
Race/ethnicity
Income
Insurance status
Data 2007 Commonwealth Fund International Health
Policy Survey.
7
EQUITY COORDINATED AND EFFICIENT CARE
Ambulatory CareSensitive (Potentially
Preventable) Hospital Admissions, by
Race/Ethnicity and Patient Income Area, 2004/2005
Adjusted rate per 100,000 population
Diabetes
Heart failure
Pediatric asthma
NA
2004 data for diabetes and pediatric asthma
2005 data for heart failure. Combines 4
diabetes admission measures uncontrolled,short-t
erm complications, long-term complications, and
lower extremity amputations. Patient Income
Areamedian income of patient zip code. NAdata
not available. Data Race/ethnicityHealthcare
Cost and Utilization Project, State Inpatient
Databases and National Hospital Discharge Survey
(AHRQ 2007b) Income areaHCUP, Nationwide
Inpatient Sample (AHRQ 2007a, retrieved from
HCUPnet at http//hcupnet.ahrq.gov).
7
8
Nonelderly Adults with Time Uninsured During the
Year,by Family Income and Race/Ethnicity, 2004
EQUITY ACCESS
Percent of nonelderly adults (ages lt65) who had
no health insurance coverage sometime during the
year
Note High refers to household incomes gt400 of
federal poverty level (FPL) middle to 200-399
FPL near poor to 100 to 199 FPL and poor to
lt100 FPL. Data Medical Expenditure Panel Survey
(AHRQ 2007b).
8
9
Cost-Related Access Problems, by Race/Ethnicity,
Income,and Insurance Status, 2007
EQUITY ACCESS
Percent of adults (ages 1964) who had any of
four access problems in past year because of cost
Did not fill a prescription skipped
recommended medical test, treatment, or
follow-up had a medical problem but did not
visit doctor or clinic or did not see a
specialist when needed. Data 2007 Commonwealth
Fund Biennial Health Insurance Survey.
9
10
Universal Health Care as a Health Disparity
Intervention

• Measures of control of diabetes, hypertension and
  cholesterol improved 10 to 21 from 1999 to 2006.
• Disparities between groups by race, ethnicity and
  education level persisted.
• Most health disparities were significantly
  smaller among participants older than 65 years
  strong circumstantial evidence that universal
  health coverage sharply narrows disparities.
• Eliminating disparities will require
  interventions that specifically target the needs
  of minorities, the poor, the uninsured and other
  disadvantaged groups.
• Editorial by Ashwini R. Sehgal, MD
• Original Article by McWilliams, Meara, Zaslavsky
  and Ayanian
• Annals of Internal Medicine 2009 150 561-562,
  and 505-515.

11
Martin Luther King, Jr.

• Cowardice asks the question is it safe?
• Expediency asks the question is it politic?
• Vanity asks the question is it popular?
• But conscience asks the question is it right?
• And there comes a time when one must
  take a position that is neither safe,
  nor politic, nor popular- but one must
  take it simply because it is right.