healthcare disparities

A few months ago there was an article in a prominent medical journal about an association with one’s income and place of death (it was looking at hospice patients only). The higher one’s income the more likely someone was to die at home with hospice rather than in a nursing home or hospital.

As a practicing physician,  that there are healthcare disparities bothers me. There are multiple factors that go into this. Some are patient related (limited english skills, little/no social support in cases of people with little mobility), some are patient and societal (I would put literacy here, not just health literacy). As of 2013 I would hope that being a member of a minority would not have an effect on one’s healthcare. There is evidence  – and i don’t recall which journal I saw this in – that minorities that go to hospitals that have good healthcare results do as well as non minorities, and those that go to hospitals with less good results have corrispondingly poorer outcomes. In this case I guess we could argue for putting systems in place for all health care institutions to give health care with good results.

One thing physicians get measured on are things like checking cholesterol levels, glycosylated hemoglobin A1c’s twice a year, etc. However  to just focus on measures like that take time and energy away from measuring and doing other things that ‘count’. Sending someone for a test and usually takes less time than spending 1/2 an hour educating patients as to why those measures count and how to take care of their health. There have been articles that have brought this issue up. There are easy answers. However, I have a feeling that at least as of 2014, having processes in place to be sure that patients are educated about disease prevention and self management would go a lot farther in preventing complications than would checking a glycosylated hemoglobin twice a a year.

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