1. TRUMAN MEDICAL CENTERS DISPARITIES: Why and What to do About Them? John W. Bluford President/CEO Truman Medical Centers Presented to The Institute for Healthcare Disparities 1 st Annual National Best Practices Conference April 17, 2009 1 st Annual Conference

2. 1 USA Public Policy Overview 1860s Bureau of Refugees, Freedmen, and Abandoned Lands 1940s Hill-Burton Act The Hospital Survey & Construction Act, 1946 1960s Medicare & Medicaid 1960-70s OEO Neighborhood Health Centers 1973 Health Maintenance Organization Act

3. 2 During Slavery

4. 3 USA Public Policy Bureau of Refugees, Freedmen, and Abandoned Lands (“Freedmen’s Bureau”) – 1860s

5. 4 Black Hospitals in the U.S. FoundedClosed Freedmen (Howard U.) 1862 George W. Hubbard (Meharry) 1884 Provident, Chicago18911987 Provident, Baltimore18941986 Mercy-Douglas, Philadelphia19101973 Homer G. Philips, St. Louis19391979 Mound Bayou, Mississippi19411983

6. 5 USA Public Policy Hill-Burton Act - 1946 (The Hospital Survey & Construction Act) Intent –Build & Modernize Hospitals –Separate-but-Equal Funding –Provide Uncompensated Care Actual –$4+ Billion Spent from 1946-1978 –Unequal Allocation of Resources Harold H. Burton U.S. Senator, Ohio Mayor Lister Hill U.S. Congressman, Alabama

7. 6 USA Public Policy NOTES PAGE 2 Harold H. Burton U.S. Senator, Ohio Mayor Lister Hill U.S. Congressman, Alabama

8. 7 Good Samaritan-Waverly Hospital Richland County, South Carolina

9. 8 As Opposed to: Major Teaching Hospitals Providing Care for Minorities Cook County – Chicago Charity – New Orleans Grady Memorial – Atlanta Jackson Memorial – Miami Harlem – New York

10. 9 USA Public Policy Medicare / Medicaid – 1960s Health Maintenance Organization Act – 1973 (HMO Act of 1973)

11. 10 What to do about Disparities as an Industry Invest in Quality Improvement –“Patient Centered” Diversify Governance Enhance Community Benefit Reporting Focus on Public Health Issues Enhance Wellness & Prevention Outreach Enhance Diverse Workforce Opportunities

12. 11 WHY? Because We Care. We are in the business of caring. To be effective, we must cross Social – Economic – Cultural barriers.