NEW HEALTH EQUITY SCORECARD: State-by-State Scorecard of Racial and Ethnic Disparities Finds All
States’ Health Systems Are Failing People of Color.
In Nearly Every State, Black Americans Are More Likely Than White Americans to Die from Preventable and Treatable Conditions Exacerbated by Lack of Timely, High-Quality Health Care
A new health equity scorecard released by the Commonwealth Fund finds
deep-seated racial and ethnic health inequities in all 50 states and the District of
Columbia — disparities that have been exacerbated by the COVID-19 pandemic.
Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State
Performance is a comprehensive examination of how health care systems are
functioning for people of color in every state. Part of the Commonwealth Fund’s
ongoing series examining individual state health system performance, the
report uses 24 measures to evaluate each state on health care access, quality and
service use, and health outcomes for Black, white, Latinx/Hispanic, American
Indian/Alaska Native (AIAN), and Asian American, Native Hawaiian, and Pacific
Islander (AANHPI) populations.
The health equity scorecard reveals that even among high-performing states,
racial and ethnic health disparities can be dramatic. For example, Minnesota’s
health care system, which has historically performed well in Commonwealth
Fund state scorecard rankings, has some of the largest health disparities between
white and nonwhite communities. Maryland, Massachusetts, and Connecticut
are other traditionally high-scoring states where white residents receive some
of the best care in the country but where quality of care is far worse for many
populations of color. Similarly, in states like Mississippi and Oklahoma whose
health care systems have historically performed poorly for both white and Black
populations, white patients still received markedly better care.
In addition to showing how people of different races and ethnicities fare within
each state, the Fund’s scorecard ranks how well each state’s health system is
working for each racial and ethnic group. For instance, the health care system in
California works better for Latinx/Hispanic people than the Texas health care
system. In both Texas and California, however, the health system benefits white
people more. Among states with large American Indian populations, South
Dakota, North Dakota, Montana, and Wyoming have the worst-performing
health systems for these communities while California’s system ranks at the
top — though there are still wide disparities with other populations in the state.
POLICY IMPLICATIONS
Structural racism and generations of disinvestment in communities of color
are chief among many factors contributing to pervasive U.S. health inequities,
the authors note. As the COVID-19 pandemic has shown, people in many
communities of color are more likely than members of white communities to
live in poverty, to work in low-paying, high-contact industries, and to reside
in high-risk living environments. Many Black, Latinx/Hispanic, and AIAN
populations then face an unequal health system when they need to access care.
They are less likely to have health insurance, more likely to face cost-related
barriers to care and medical debt, and more likely to receive suboptimal care.
Health inequities are perpetuated and reinforced by each of these contributing
factors — all of which have their roots in both past and current policies at the
federal, state, and local levels. The authors suggest pursuing four broad policy
goals to create an equitable, antiracist health system:
1. Ensuring affordable, comprehensive, and equitable health insurance
coverage for all
2. Strengthening primary care
3. Lowering administrative burden for patients
4. Investing in social services.
Since health inequities vary across states, there are also opportunities for
state programs to tailor interventions that address the unique needs of their
communities.
HOW WE CONDUCTED THIS STUDY
State health system performance was evaluated for each of five racial and ethnic
groups — Black (non-Latinx/Hispanic), white (non-Latinx/Hispanic), AIAN
(non-Latinx/Hispanic), AANHPI (non-Latinx/Hispanic), and Latinx/Hispanic
(any race) — among 24 indicators of health system performance. Indicators were
grouped into three performance domains: health outcomes, health care access,
and quality and use of health care services.
For each of the 24 indicators, the researchers calculated a standardized score
for each state/population group with sufficient data (e.g., Latinx/Hispanic
individuals in Texas). Within each performance domain, they combined
indicator values to create a summary score. The domain summary scores in each
state were then combined to create a composite state health system performance
score for each racial and ethnic group.
Based on the overall composite scores, each racial/ethnic group within each state
received a percentile score providing both national and state-level context on the
performance of a state health system for that population. The percentile scoring,
from 1 (worst) to 100 (best), reflects the observed distribution of health system
performance for all groups measured in this report and enables comparisons
within and across states. For example, California’s health system score of 50
for Latinx/Hispanic individuals indicates that it is performing better for those
residents than Florida’s health system does for Latinx/Hispanic people, with a
score of 38. However, both groups fare worse than white residents in California,
where the health system performs at a score of 89 for them.
Read More: https://www.commonwealthfund.org/publications/scorecard/2021/nov/achieving-racial-ethnic-equity-us-health-care-state-performance