A PHS 795 student comments on a piece in the most recent issue of Health Affairs outlining the history of major policy initiatives on health equity in the US:
Ushering In The New Era Of Health Equity
Ushering In The New Era Of Health Equity | At the intersection of health, health care, and policy.
The author first outlines the 3 “eras” of health equity in the US. The first came in 2001 with the IOM’s Crossing the Quality Chasm and the book Unequal Treatment, which highlighted the presence of disparities. The second era started with the passage of the ACA and the new emphasis on access to care, and attempts to achieve the Triple Aim. Finally, the third era is here, in part because of the passage of MACRA (Medicare Access and CHIP Re-Authorization Act, which he calls the best ABC of health yet—an acronym with in an acronym).
Interestingly, some of the alternative payment and delivery mechanism are reproducing disparities. ACO are less likely to recruit doctors who take care of minority patients and MIPS (merit-based incentive programs) are less likely to exist in minority communities.Betancourt argues that in order to achieve equity in the third era, we have to ensure that some patients are not benefiting from reforms more than others.
This article highlighted many of the themes discussed in Dr. Dugoff and Dr. Jacob’s lectures. It is interesting to examine who has access to alternative payment models, the impact on both the quality of care they have access to and their subsequent health outcomes. As we’ve talked about in class, even where health outcomes are improving, health disparities persist. This article makes it clear that access to health insurance/ providers is not enough to end health disparities. Given how much care delivery is changing, access to these new innovative models may make a huge difference in both outcomes and either perpetuating or combatting health disparities.
Something to think about as we kick off OE4. (for the non-health policy nerds, today is the beginning of the 4th open enrollment period for the ACA marketplaces)