As overall care quality improves, socioeconomic disparities remain

A new report finds that the overall quality of healthcare in the United States continues to show gradual improvement. Among demographic groups, however, that improvement remains uneven.

Data from a new report published by the Agency for Healthcare Research and Quality (AHRQ), show the country has made significant gains in insurance coverage, patient safety and person-centered care, as well as healthy living, effective treatment and care coordination. The report also finds evidence of persistent disparities in care quality among groups defined by race, ethnicity or income.

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A recent post on the Health Affairs Blog suggests the disparities tied to socioeconomic status can have a snowball effect, citing research that demonstrates wage reductions of 18% after the onset of chronic disease. Such a scenario generates widening socioeconomic gaps alongside greater disparities in care outcomes, suggesting an urgent need to attack the problem from any available angle.

To that end, the federal government has focused resources on improving the quality of care provided in the country. This week, the U.S. Department of Health and Human Services awarded $105 million to 1,333 health centers across the country as an investment in quality improvement. Still, disparities persist, even in areas surrounding world-class facilities, a dynamic that has some hospitals scrambling to develop more effective community outreach.

The AHRQ report shows evidence that some efforts may be getting limited traction, with 20% of the 250 quality measures covered showing improvements in care gaps among black and Hispanic groups. Nevertheless, the report indicates significant disparities across all priority areas, particularly for poor and uninsured populations.

Lack of insurance drove disparities among nearly two-thirds of the measures, according to the report. The decrease in numbers of uninsured tracked since 2010 has played a factor in the overall improvement, with the largest increases clustered among Hispanic populations, individuals aged 18 to 29, and adults with incomes near the federal poverty level. This tracks with other data showing changes to the system required by the ACA, particularly Medicaid expansion, have helped to narrow socioeconomic gaps in care.