Health Care Differs by Color

by Marsha D. Thomas, RN

Despite notable progress in the overall health of the U.S., there are continuing disparities in the burden of illness and death experienced by blacks, Hispanics, American Indians and Alaska Natives and Pacific Islanders, compared to the population as a whole. Groups currently experiencing poorer health status are expected to grow as a proportion of the total U.S. population.

U.S. Surgeon General David Satcher called on health officials and other advocates to eliminate health disparities among racial and ethnic groups and to work to help people live longer -- and healthier. Yet, the statistics are troubling. For example, compared with whites, African-Americans

• wait longer for kidney transplants and are less likely to receive a kidney;
• get bypass operations at a rate less than one quarter that of whites;
• receive angioplasties at one-third the rate of whites;
• are 13 percent less likely to get a coronary bypass.
• Those with diabetes and circulatory problems get more leg amputations, but fewer leg saving operations than whites. African-American women are less likely to be referred for cardiac catheterizations.

According to a Kaiser survey, 64 percent of African-Americans and 56 percent of Latinos believe that they receive lower-quality health care than whites. Most whites believe that the quality of health care for themselves and minorities is the same. In addition, 35 percent of African-Americans and 36 percent of Latinos believe that they or someone they know had been treated unfairly because of race when seeking medical care, compared with 15 percent of whites.

We spend $1 trillion a year for health care in this country and only 1 percent of that is spent on population-based prevention programs. An African American baby born today, for example, is 2 times more likely to die in the first year of life than a white counterpart. Indian babies are more likely to die of sudden infant death syndrome than any other group. Similarly, Latinos of all ages are twice as like to die from diabetes as their white counterparts. Asian Americans are more likely to die from hepatitis-related liver cancer than whites.

What can we do? First, we need aggressive enforcement of anti-discrimination laws. We also need culturally competent health care providers. It is time for more medical schools and hospitals to develop classes and other comprehensive training programs to ensure that all health care professionals are culturally competent. Only about a dozen medical schools currently require students to enroll in such a course. We need improved methods of collection and use of standardized data to correctly identify all high-risk populations and monitor the effectiveness of health interventions targeting these groups. Further, we need to work more closely with communities to identify culturally sensitive implementation strategies. We must also educate patients. We must teach patients that it is OK to ask for a second opinion, OK to demand an explanation from a doctor about what he or she is planning to do, and OK to complain when they have not received adequate, respectful treatment.

Dr. King once said: peace is not simply the absence of violence but the presence of justice. It is time to recognize that eliminating health disparities is both a public health and a civil rights challenge. It is a matter of justice.

Marsha Thomas currently runs a parish nurse program in Cincinnati which places RNs in faith-based communities. She is also very active as program chair of The National Black Women's Health Project.

From the Director, Larry Bresler

Considerable attention has been focused on Cleveland because of the current health care crisis. After the closing of two of Cleveland's major safety net hospitals, St Luke's and Mt. Sinai, the community surrounding another hospital, St Michael, rallied to halt its closing.

At the same time, MetroHealth, Cuyahoga County's public hospital, announced major cuts in staffing and other support services as a result of a large and mounting deficit. One major cause of the deficit is inadequate governmental reimbursements at a time when there are large increases in Medicaid and uninsured patients because of the hospital closings and because those who left welfare found work without health care.

Cleveland's health care crisis raises statewide issues that must be addressed.

• Regulatory legislation is lacking. In 1996 Ohio repealed its Certificate of Need law which required hospital acquisitions, closings, and additions to go through a process of public review.
• Reimbursements funneled through Medicaid HMOs are less than those received directly from the state. In counties with mandatory Medicaid managed care, that disparity financially hurts hospitals and providers who serve poor people.
• Several Medicaid HMOs have failed, leaving significant health care debts to providers. Since the State mandated the use of these HMOs, the State should be the fiscal guarantor.
• The Hospital Care Assurance Program, which provides hospital reimbursement for uninsured care to persons living below the poverty line needs to be reevaluated upward to cover more uninsured.
• The tobacco suit settlement of $10 billion over 25 years should be used primarily for health care needs as it was intended.

Currently, the Ohio Legislature's sole response to Ohio's
health care needs is Senate Bill 264, a bandaid piece of legislation that will provide two years of limited funds to hospitals for uncompensated uninsured care to address the "unanticipated consequences" of people coming off of welfare without employer financed health insurance.

The Ohio State Legislature must provide adequate funding and resources to hospitals and primary care providers serving vulnerable populations. Ohio must also have a system in which those using public dollars -- including health care institutions -- are publicly accountable for services to the community.

Work in Progress

A report on organizational activities

CLEVELAND

Coalition Efforts Work

Last December, UHCAN Ohio staff began organizing a group of social service providers, community members and advocates on the Near West Side of Cleveland concerned about access to health care for immigrants and for persons with limited English proficiency. Representatives from over a dozen organizations formed the Immigrant (and Limited English Proficient) Health Care Access Coalition to work for access to free care for indigent immigrants excluded from Medicaid and other free care programs, improved translator services, and culturally sensitive care.

We had our first major victory when, through the advocacy of MetroHealth administrator Barbara West, MetroHealth Medical Center changed its free care policy to include immigrants regardless of immigration status. We are continuing to work with Ms. West to improve patient access to the interpreter services provided by MetroHealth, and we are creating a booklet in various languages which will explain patient rights and available services in Cuyahoga County for immigrants and other persons with limited English proficiency. (For more information, contact Cindy Maxey at 216/241-8422.)

UHCAN Ohio Participates in National Research Study

The Access Project, a national initiative of the Robert Wood Johnson Foundation, has selected UHCAN Ohio to participate in a national survey project to identify barriers to health care for the uninsured. We are one of 24 groups from across the nation selected.

We will conduct one-on-one interviews with uninsured patients who have received services from any one of four targeted Cleveland hospitals. Interviewees will be asked about their experiences and opinions.

We already know that uninsured individuals have greater rates of potentially avoidable -- and frequently more costly -- hospitalizations as well as greater reliance on the emergency room than the insured. We hope to use the data to find solutions that both can improve health care and minimize costly and avoidable treatments.

COLUMBUS

Free Care at Hospitals: A Shredded Safety Net

You're uninsured, with a low income. You're sick or injured, so you go to your local hospital for treatment. Then you get the bill. Did anyone tell you to apply for free care? Maybe yes, most likely no.

Ohio law (Health Care Assurance Program, or HCAP) requires hospitals to provide medically necessary care to people with incomes under federal poverty level. Many nonprofit hospitals have their own charity care programs for people near poverty. Nonprofit hospitals are a vital part of our safety net for the uninsured. But unpaid hospital bills fill the drawers of many Ohio residents who qualify for free care but don't know it. And hospitals lose money when they do not qualify eligible people for HCAP. UHCAN Ohio's Community Group on OSU East is working to make sure patients know about available free care.

In addition, few Columbus hospitals are taking advantage of AEMA, the Alien Emergency Medical Act. Part of the Ohio Administrative Code, AEMA pays provider claims for emergency services (including labor and delivery) to people financially eligible for Medicaid who are disqualified because of immigration status.

Here are some of the things UHCAN Ohio's Columbus office is doing about free care:

• Monitoring local hospitals to see if they tell people about free care or have simple handouts about free care policies and application procedures;
• Developing handouts for community groups about HCAP and hospital free care policies;
• Talking to hospital administrators about better ways to let uninsured patients know about HCAP and free care and teaching them to use AEMA.

If you are interested in working with hospitals in your community or want to know more about free care laws and programs, call Cathy Levine at 614/253-4340.

Win for the Language Task Force

LTF learned recently that Ohio Health (Grant, Riverside and 2 Doctors Hospitals) will hire a coordinator of interpreter services -- a major LTF recommendation to the hospital system's task force last year. LTF congratulates the Grant/Riverside Diversity Task Force and the hospitals on taking a major step forward.

Ohio Legislation Highlights

For more information on pending bills, call UHCAN Ohio's policy director, Cathy Levine, at 614/ 253-4340. Full texts and summaries of bills are available on the state's website:
www. legislature.state.oh.us.

SB 192, The Tobacco Settlement
In February, Goveror Taft signed the legislature's plan for using the $10 billion tobacco settlement, slashing health funds by 75 percent from the earlier version. Many states used tobacco funds to improve health care, but not Ohio -- even though we rank among the most unhealthy states.

National rates for leading killers -- heart disease, cancer, stroke, chronic obstructive pulmonary diseases and diabetes -- have remained steady or declined, but are rising in Ohio. Racial disparities are even worse: for instance, the death rate from diabetes for Black males in Columbus is 4 times the national death rate. Yet, the legislature is using only 5 percent of funds through FY 2012 on public health priorities.
The good news is, the next legislature could change the plan -- but only with a groundswell of pressure on legislators to use more tobacco funds on health care.

SB 264 would distribute $50 million per year, from the state's General Revenue Fund, to hospitals based on the amount of uncompensated care they report. Although SB 264 would help some hospitals, UHCAN Ohio has some concerns. First, this bandage will not staunch the major bleeding in Ohio's health care systems (see Health Care Institution Responsibility Act, below).And, no funds go to the community health centers, which are also hurting from increased numbers of uninsured patients and shrinking reimbursements.

The Health Care Institution Responsibility Model Act: UHCAN Ohio is looking for sponsors and supporters in Ohio. The Model Act recognizes that health services providers, i.e., hospitals and HMOs, are important sources of health care services and must contribute to addressing unmet health needs. The act would require all providers to: (1) provide "community benefits"- unreimbursed goods and services (including free and below-cost care) - to address community identified health needs, especially for the uninsured; (2) develop a plan, with community participation; and, (3) produce an annual report to ensure public evaluation of spending and programs. Providers would have to create a clear written policy on free care and a system for advertising free care.
This Model Act uses existing laws, where applicable (13 states already have laws, regulations and/or guidelines on community benefits). The Model Act was drafted by advocacy organizations Community Catalyst and Consumers Union. Copies are available in the Columbus and Cleveland offices.

UHCAN Ohio
CLEVELAND -- 216/241-8422 or 800/634-4442
COLUMBUS -- 614/253-4340
www.uhcanohio.org