An “overwhelming” 88% of respondents reporting healthcare discrimination in a new screening initiative were Black, according to a new Humana study.
The report focused on the structural determinants of health as opposed to the more common social determinants of health. While such social determinants center on the conditions in which people live, work, play, learn and worship, structural determinants focus on the economic and social experiences and policies that influence health such as discrimination and health literacy. Both social and structural determinants are often interrelated, according to the study authors.
The study, published in the American Journal of Managed Care, is the first of its kind by a U.S. insurer to focus on the structural determinants of health, aspects which are “critical” but often overlooked, Humana said.
The healthcare discrimination finding was somewhat problematic given a small sample size and how exactly to frame and ask questions but was nevertheless quite instructive, said co-author J. Nwando Olayiwola, M.D., chief health equity officer and senior vice president at Humana.
“While a larger sample size would be helpful to draw conclusions, the results from this small sample are not surprising,” she told Fierce Healthcare. “Black patients were the most likely to report perceived healthcare discrimination, and this has been found in other studies as well.”
As well as the high Black discrimination finding, other data from the survey included almost 20% of respondents reporting low or limited health literacy. Such patients were also more likely to be Black, low income and report feelings of loneliness and isolation as well as food insecurity, the study found.
The pilot screening will allow Humana to gain a deeper understanding of patient experiences which in turn can lead to more targeted interventions to address such barriers.
“Because the literature on implementing these screenings in managed care settings is so limited, we felt it was important to understand the feasibility of screening using evidence-based, validated screening instruments and train our staff to administer them,” said co-author Candy Magaña, director of health equity innovation, solutions and transformation at Humana. “This builds off our longstanding expertise in screening members for various social needs.”
The survey showed varying feasibility results regarding health literacy and perceived healthcare discrimination screenings with health literacy here offering a higher response rate.
“We believe this study is an important first step in highlighting some of these relationships for the healthcare ecosystem to take action and have the tools to center health equity as a core goal for all,” the authors concluded.
The study involved 406 newly enrolled Medicare Advantage patients with questions carried out between December 2021 and March 2022. Women made up 60.1% of the enrolled patients with White (58.4%) and Black (27.8%) respondents making up most of those surveyed. Most screened patients (67.5%) were 70 years old or above.
Leveraging such data to take tangible action to improve outcomes for affected patients will be key, said Olayiwola.
“The perception of discrimination by your clinician can lead to mistrust, confusion and non-adherence to treatment or preventive care plans,” she said. “Making every patient feel safe and respected is important to providing high quality care.”