Using Performance Indicators to Improve

Health Equity & Quality

By Davontae Foxx-Drew
Abstract

This study examines the performance of the state's health system for five racial/ethnic groups by
looking at health outcomes, access to care, and the quality/use of health care services using 24
factors. The research samples members of the following racial and ethnic groups: American
Indians and Alaska Natives (non-Latinx or Hispanic) and African Americans (non-Latinx and
Hispanic) are the only non-Latinx/Hispanic groups in the United States.

Introduction impact on people of color populations is due

to high poverty rates, low-paying jobs, and
People of color in the United States have high-risk locales.6
historically had significantly different health
and well-being outcomes. For example, the Disparities are further exacerbated by cost,
average life expectancy of African affordability, and access to care concerns.
American and American Indian/Alaska Black, Latinx/Hispanics, and Asians are less
Native (AIAN) people is lower than white likely to have health insurance and more
individuals.1 Moreover, African American common medical debt.7 This demographic is
women are more likely to die from also less likely to have a regular health care
avoidable causes, die during or after provider or get preventive treatments like
pregnancy, have pregnancy-related severe immunizations.8 Many people of color are
issues, and lose their babies in infancy.2 also subjected to intergroup racism and
Additionally, black and Asian-American discrimination by medical professionals and
people are more likely to suffer from many receive inequitable care compared to their
chronic health conditions, including diabetes counterparts.9
and hypertension.3 The COVID-19
pandemic has compounded the situation, For decades, federal, state, and local policy
with the average life expectancy declining choices have resulted in poor health for
more precipitously for black, many African American communities.10 In
Latinx/Hispanic, and, most likely, AIAN addition, health care disparities have been
people than white populations.4 exacerbated by the lack of universal health
coverage for all Americans. As a result,
Additionally, the health condition of there is a general acceptance of a gap in
individuals varies significantly throughout health care quality. Yet, as long as
and across states, as does access to health institutionalized racism exists in every state,
care and the overall quality of care. As a some states officials refuse to adopt
result of internal and external factors to the initiatives that might help minimize health
health care delivery system, substantial disparities, such as expanding Medicaid
inequalities in health outcomes exist eligibility as mandated by federal law.11 12
between people of different races and
ethnicities.5 COVID-19's disproportionate
As part of its goal to improve people's health Texas and California, white people benefit
and care, the Commonwealth Fund has kept more from the healthcare system. Finally,
a scorecard on state health systems since states with a significant population of
1999. However, looking at a state's overall American Indians have the worst health care
health system performance might not show systems in the country. Although there are
that there are significant problems. So, the still substantial differences between
health of AIAN, Asian American, Native California and other organizations in the
Hawaiian, and Pacific Islander (AANHPI) state, the state's approach is the most
people are looked at both inside and outside effective.
each state. In the future, research expects
policymakers and people in charge of health Recommendations
care systems to use this tool to figure out
how past policies have affected people A wide range of differences in health
health from different races and cultures. outcomes and healthcare access occur
amongst ethnic groups in the same state.
Findings Improved policies and practices are thus
required to ensure that all patients get
Each state's health care system is evaluated equitable treatment and make health care
based on 24 variables, including outcomes more widely available.
for black, whites, Latinxs/Hispanics,
American Indians/Alaska Natives, Asian Structural racism and decades of
Americans, Native Hawaiians, and Pacific underinvestment in communities of color are
Islander descent. two significant factors in the disparity in
health outcomes in the United States. As the
The health equity scorecard reveals that COVID-19 outbreak has shown, people of
racial and ethnic health disparities persist color are more likely than whites to live in
even in high-performing counties. poverty, work in low-paying jobs with high
Minnesota's health care system, which has contact rates, and reside in high-risk areas,
consistently ranked well in the as was proved by the epidemic. In addition,
Commonwealth Fund state scorecard the health care system is biased towards
rankings, is an example of health disparities people of color and Latinx/Hispanics and
between white and nonwhite populations. In AIANs in general, which makes it difficult
Maryland, Massachusetts, and Connecticut, for many of these groups to get adequate
white people get some of the best care, medical attention. So, they are more likely
while many people of color communities are to be uninsured, face financial impediments
underserved. Historically, Mississippi and to treatment, accumulate medical debt, and
Oklahoma have poor healthcare systems for get poor care.
white and black populations, although white
patients received more treatment. Each of these contributing elements has its
origins in historical and present policy at the
Each state's health care system is evaluated federal, state, and local levels, perpetuating
according to the Fund's scorecard, which and reinforcing health disparities. In creating
considers racial and cultural diversity. For an anti-racist, egalitarian health care system,
example, California's Latinx/Hispanic the Fund recommends pursuing four main
population receives higher care quality than policy objectives:
Texas's healthcare system. However, in
 1. Ensuring affordable, comprehensive, of the United States of America and
and equitable health insurance continues to do so now. We need to enact
coverage for all new policies that promote racial and ethnic
2. Strengthening primary care equity, increase access to affordable, high-
3. Lowering administrative burden for quality treatment, and empower primary
patients care personnel to ensure that the health care
4. Investing in social services. system serves all Americans.

State programs may adjust interventions to References

meet the specific needs of their communities
since health inequalities differ by state.

Conclusion

Equitable access to healthcare for all people,

regardless of race or ethnicity, should be a
priority for federal and state governments.
Recognizing the laws and regulations that
impede progress toward health equity is the
first step.

Health authorities should reevaluate present

rules and regulations to understand how they
influence the accessibility of high-quality
healthcare for people of color to solve
widespread health inequalities. In addition,
the United States needs additional measures
to provide appropriate insurance coverage
and timely access to both general and
specialist care in underserved parts of the
nation.

The development and implementation of

equity-focused metrics to monitor the
performance of health equity programs and
drive accountability for achieving desired
outcomes are critical. In addition,
governments and healthcare systems must
track health disparities in clinical outcomes
and other health outcomes and insurance
plans to eliminate them.

Health care in the United States is too often

connected with race and ethnicity.
Furthermore, in federal and state laws,
racism has existed long before the founding
1
Elizabeth Arias et al., Provisional Life Expectancy Estimates for 2020 (NCHS Vital Statistics Rapid Release, July 2021); and
Elizabeth Arias et al., “Mortality Profile of the Non-Hispanic American Indian or Alaska Native Population, 2019,” National
Vital Statistics Reports 70, no. 12 (Nov. 2021).
2
“Mortality amenable to health care,” Commonwealth Fund Health Systems Data Center and calculations from 2018–19
CDC National Vital Statistics System (NVSS); Eugene Declercq and Laurie Zephyrin, Maternal Mortality in the United States:
A Primer (Commonwealth Fund, Dec. 2020); “Infant Mortality,” Commonwealth Fund Health Systems Data Center, n.d.;
and “Infant Mortality,” CDC, 2021.
3
Jesse C. Baumgartner et al., Inequities in Health and Health Care in Black and Latinx/Hispanic Communities: 23 Charts
(Commonwealth Fund, June 2021; and “Disparities Fact Sheet,” Indian Health Service, Oct. 2019.
4
Arias et al., Provisional Life Expectancy, 2021; Jessica Arrazola et al., “COVID-19 Mortality Among American Indian and
Alaska Native Persons — 14 States, January–June 2020,” Morbidity and Mortality Weekly Report (MMWR) 69, no. 49 (Dec.
2020): 1853–56.
5
David C. Radley, Sara R. Collins and Jesse C. Baumgartner, 2020 Scorecard on State Health System Performance
(Commonwealth Fund, Sept. 2020).
6
Gina Kolata, “Social Inequities Explain Racial Gaps in Pandemic, Studies Find,” New York Times, Dec. 9, 2020; Samrachana
Adhikari et al., “Assessment of Community-Level Disparities in Coronavirus Disease 2019 (COVID-19) Infections and Deaths
in Large U.S. Metropolitan Areas,” JAMA Network Open 3, no. 7 (July 2020): e2016938; and Nancy Krieger, Pamela D.
Waterman, and Jarvis T. Chen, “COVID-19 and Overall Mortality Inequities in the Surge in Death Rates by Zip Code
Characteristics: Massachusetts, January 1 to May 19, 2020,” American Journal of Public Health 110, no. 12 (Dec. 2020):
1850–52.
7
Shiwani Mahajan et al., “Trends in Differences in Health Status and Health Care Access and Affordability by Race and
Ethnicity in the United States, 1999–2018,” JAMA 326, no. 7 (Aug. 17, 2021): 637–48; Health Insurance Coverage and
Access to Care for American Indians and Alaska Natives: Current Trends and Key Challenges (ASPE, July 2021); and Sara R.
Collins, Gabriella N. Aboulafia, and Munira Z. Gunja, As the Pandemic Eases, What Is the State of Health Care Coverage
and Affordability in the U.S.? Findings from the Commonwealth Fund Health Care Coverage and COVID-19 Survey, March–
June 2021 (Commonwealth Fund, July 2021).
8
Mahajan et al., “Trends in Differences,” 2021; Jesse C. Baumgartner, Sara R. Collins, and David C. Radley, Racial and
Ethnic Inequities in Health Care Coverage and Access, 2013–2019 (Commonwealth Fund, June 2021). See Appendix A2.
9
Brian D. Smedley, Adrienne Y. Stith, and Alan R. Nelson, Unequal Treatment: Confronting Racial and Ethnic Disparities in
Health Care (Institute of Medicine, 2003); Kiran Clair et al., “Disparities by Race, Socioeconomic Status, and Insurance Type
in the Receipt of NCCN Guideline-Concordant Care for Select Cancer Types in California,” Journal of Clinical Oncology 38,
no. 15 suppl. (May 20, 2020): 7031; and William L. Schpero et al., “For Selected Services, Blacks and Hispanics More Likely
to Receive Low-Value Care Than Whites,” Health Affairs 36, no. 6 (June 2017): 1065–69.
10
Zinzi D. Bailey, Justin M. Feldman, and Mary T. Bassett, “How Structural Racism Works — Racist Policies as a Root Cause
of U.S. Racial Health Inequities,” New England Journal of Medicine 384, no. 8 (Feb. 25, 2021): 768–73; and Jamila Taylor,
Racism, Inequality, and Health Care for African Americans (Century Foundation, Dec. 2019).
11
Bailey, Feldman, and Bassett, “How Structural Racism Works,” 2021.
12
Jennifer Karas Montez et al., “U.S. State Policies, Politics, and Life Expectancy,” Milbank Quarterly 98, no. 3 (Sept. 2020):
668–99; and Jamila Michener, “Race, Politics, and the Affordable Care Act,” Journal of Health Politics, Policy and Law 45,
no. 4 (Aug. 2020): 547–66.