1. Social Equity: Health and Healthcare Indicators Richard W. Hug Fifth Social Equity Leadership Conference Omaha, Nebraska February 2, 2006

2. Outline Social Equity Defined Key Indicators Initiatives Resources Box / Eikenberry Dimensions – (ADPQO) −Access / Distribution −Process −Quality −Outcomes

3. Social Equity -- Defined Social equity is the fair, just and equitable management of all institutions serving the public directly or by contract. This includes the fair, just and equitable distribution of public service and the implementation of public policy and the commitment to promote fairness, justice, and equity in the formation of public policy. (Sounding the Call, p. 1)

4. Social Equity Indicator Areas Access / Distribution -- a commitment to reduce omission and neglect that contribute to systematic inequality in access to services. Procedural Fairness – a determination to eliminate acts of commission that deprive individuals of fair and consistent treatment and to act with urgency when members of groups are systematically treated unfairly.

5. Indicator Areas (continued) Quality – ensures that those who receive services and benefits are not slighted and consigned to a level of quality that does not measure up to acceptable standards Outcomes – rejects systematic differences in life chances across groups in society – promotes the idea of narrowing and eliminating disparities

6. Indicators – Access / Distribution Source – The National Healthcare Disparities Reports (NHDR) Getting into the system −Health Insurance −Usual Source of care Utilization Summary Measures

7. . Exhibit 1 – Health Insurance Coverage by Ethnicity and Age, 2004 Source: Rhoades, J.A. The Uninsured in America, 2004: Estimates for the Noninstitutionalized Population under Age 65. Statistical Brief #83. June 2005, Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/papers/st83/stat83.pdf http://www.meps.ahrq.gov/papers/st83/stat83.pdf

8. Exhibit 2 -- Selected indicators of the usual source of care, by race / ethnicity, 2001 Source: NHDR – Tables 128, 129, and 131

9. Exhibit 3 -- Selected indicators of the usual source of care, by income, 2001 Source: NHDR, Table 128, 129, and 131

10. Exhibit 4 -- Selected Indicators of Utilization of Health Care Services, by Racial / Ethnic Group, 2001 Source: NHDR Tables 65, 171, and 196

11. Exhibit 5 -- NHDR Summary Measures of Access – Percent of the Access Measures (n=31) for Which the Group’s Access was Worse than the Comparison Group

12. Indicators – Procedural Equity Referrals to specialists Explanations of conditions Respect Waiting time

13. Exhibit 6 -- Selected Procedural Equity Indicators, by Ethnicity, 2001 Source: NHDR Tables 144, 152

14. Exhibit 7 -- Selected Procedural Equity Measures, by Income, 2001 Source: NHDR Tables 144, 152

15. Exhibit 8 -- Selected Indicators of Procedural Equity, by Ethnicity, 2001 Source: NHDR Tables 146, 153, and 157

16. Indicators -- Quality Disease Management Preventive Care Overall Satisfaction Summary Measures

17. Exhibit 9 -- Selected Quality Indicators by race/ ethnicity, 2001

18. Exhibit 10 -- Summary of Selected Quality indicator disparities Indicator Race Ethnic Income EducationInsurance Hemoglobin * * * Child vaccinations * * * Adult vacccinations * * * * * Satisfaction * * * * Key * -- difference blank – no difference Source: NHDR Report

19. Exhibit 11 -- Selected Quality Measures 2001

20. Exhibit 12 -- NHDR Summary Measures of Quality– Percent of the Measures for Which the Group’s Quality of Care was Worse than the Comparison Group

21. Indicators – Outcomes Mortality Rates −Maternal and Infant −Heart Disease −Cancer

22. Exhibit 13 -- Assorted infant and maternal mortality rates, by race / ethnicity, 2001

23. Exhibit 14 -- Mortality Rates for selected diseases – heart -- by race / ethnicity, 2001

24. Exhibit 15 -- Selected Cancer Mortality Rates by Race / Ethnicity, 2002

25. Outcomes – Some other Numbers 83,369 (2000) – Satcher, 2005 25% -- 75% 4 / 34

26. Conclusion There are numerous, often large, health disparities in all the social equity measurement areas – −Access / Distribution −Procedural Equity −Quality −Outcomes

27. Things that I won’t have time to talk about … Initiatives −Access -- −Procedural −Quality −Outcomes Resources Box paper Eikenberry paper

28. Initiatives Access / Distribution −SCHIP, CHC, 23-42 Procedural equity −OCR, LEP, CC Quality −QIO’s, QAPI’s, IOM-NQCB Outcomes −COP, HDC’s

29. Resources Access Distribution −NHDR, Satcher – Pamies, Health Affairs Procedural Equity −DB Smith Quality −NHQR, IOM reports Outcomes −Williams and Jackson,

30. Social Equity: Health and Healthcare Indicators Richard W. Hug Fifth Social Equity Leadership Conference Omaha, Nebraska February 2, 2006