Nearly 2 dozen states are considering reform legislation to change insurance coverage and regulation.

States can eliminate racial and ethnic healthcare disparities by improving the healthcare infrastructure in underserved communities and stimulating the growth of culturally and linguistically appropriate services, says a recent article published on the Health Affairs Web site.

The article, “Moving Beyond Access: Achieving Equity In State Health Care Reform,” recommends that states implement policy strategies to complement insurance coverage expansions such as evaluating healthcare access and quality, state healthcare infrastructure, and levels of patient and community empowerment. 

States should adopt the following policies to complement the state insurance coverage expansions, the article says:

Improving healthcare access: Minority groups (racial, ethnic and language) encounter problems getting access to healthcare -- about half of the nation’s 47 million uninsured are racial minorities.

Ensuring rational and fair sharing of healthcare costs: High deductibles and out-of-pocket costs hurt low-income and minority patients’ ability to obtain needed care. States must have equitable cost-sharing policies like public subsidies for those with low incomes to purchase health insurance, sliding-fee scales for premiums, and limits on copayments and other out-of-pocket costs that can help reduce the disparities, the article says.

Encouraging cultural and linguistic competence in healthcare settings: Federally funded healthcare organizations are mandated to meet four of the federal Culturally and Linguistically Appropriate Services standards. However, states can create incentives, such as bonus payments under Medicaid or the State Children’s Health Insurance Program, to promote more widespread adoption of the standards.

Promoting diversity among healthcare professionals: States can develop diversity efforts through methods like loan-repayment programs and service grants, health professions pipeline programs, and other incentives for service.

Enhancing and streamlining public health insurance enrollment procedures: States can increase minority participation in public programs by developing and sustaining aggressive outreach programs and by streamlining enrollment with particular attention to the needs of cultural- and language-minority groups.

Assessing outreach and enrollment programs: States should regularly conduct evaluations of public insurance take-up rates in low-income and minority communities to ensure that healthcare expansion efforts reach underserved groups.

Introduce Performance Measures

To improve quality of care, states can provide incentives for quality improvement, such as pay-for-performance programs, performance measurement, and report cards, the article says.

But because underserved communities are typically sicker and face greater barriers to treatment compliance than other communities, performance measurement can inadvertently dampen providers’ enthusiasm for treating low-income communities or minority communities. Quality-improvement efforts should take into account the challenges and needs of underserved communities and reward efforts that reduce disparities and improve patient outcomes relative to baseline measures.

Encourage Community And Patient Input

Communities and patients should be authorized to make decisions about the state healthcare policies that affect them. This can be done in several ways, the

study proposes:

Improving patient education programs: Developing and strengthening patient education programs can enable patients to effectively navigate healthcare systems and ensure that their needs and preferences are met. For example, patient education programs have been found to be effective in reducing racial and ethnic disparities in pain control.

Encouraging community health workers: Community health workers can work in medically underserved communities to teach disease prevention, conduct simple assessments of health problems, and to help residents obtain appropriate health resources. States can encourage these programs by providing grants, seed money or other resources to help encourage their spread.

Promoting community health planning: Community health planning seeks to strengthen communities to play a greater role in their own health by actively involving residents in the planning, evaluation and implementation of health activities in their communities.

Shore Up State Health Infrastructure

A high rate of uninsurance among racial and ethnic minorities is associated with lower levels of healthcare resources (such as private practitioners, hospitals and healthcare centers) in minority communities, the article says. States can fill in resource gaps by implementing the following:

Supporting “safety-net” hospitals: Most low-income patients and minority patients seek healthcare in safety-net institutions, such as public hospitals and community health centers. These institutions are usually financially vulnerable because of low Medicaid reimbursement rates or the costs of providing uncompensated care to uninsured patients. State insurance coverage expansions will help those institutions that need state and local subsidies until universal health insurance coverage is attained.