The experience with COVID-19 over the last two and a half years has taught health care policymakers a number of important lessons. One of the most significant is the clear evidence that, notwithstanding efforts in recent years to increase access to quality health care for all people, the health equity gap remains.
And that gap was significant during COVID-19. The rates of test-confirmed COVID-19 diagnosis and exposure, hospitalization and death in New York City all show substantial racial and ethnic disparities. However, the gap was not limited to COVID-19. Those outcomes reflect preexisting differences in social determinants of health – things like education, jobs and neighborhood characteristics – that together result in poorer outcomes generally for impacted populations.
Of course, it is one thing to identify a problem, but it’s quite another to come up with a solution. And because of all the moving parts, the health equity puzzle is complex. For a long time, policymakers focused on coverage, the thought being that the fundamental problem of health equity was that some populations had no way to pay for care. And all of that has had a positive impact. But it has not solved the issue of health care disparity. Certainly, coverage issues linger. But evidence also suggests that even where coverage is available, some people still are not getting the care they need.
And policymakers, payers and providers are beginning to respond. When it comes to social determinants of health like education, housing, food, child care, etc., policymakers are incentivizing – and in some cases mandating – relationships between providers and community-based organizations that provide a variety of these social supports and services. Providers, in turn, are building those relationships, recognizing that not only is this a mechanism for improving population health generally – it also will improve providers’ bottom lines in an environment where they are being paid for patient outcomes rather than just units of service.
These efforts are also closely related to cultural competency. Not only do providers of health care services and social determinants of health need to account for those social determinants – they need to do so in a way that encourages diverse populations to use available services. Perhaps the most obvious factor here is language – if people cannot find a provider who speaks the same language, they are less likely to seek out services. But it goes far beyond that – they also need providers who understand their cultural assumptions. On a more basic level, studies have found that patients respond better to providers who simply look like they do.
And cultural competency is not restricted to race and ethnicity. Several providers have had great success in providing services (sometimes in partnership with community-based organizations) that focus on serving the LGBTQ population. Increasingly, providers are also recognizing the value in focusing on the delivery of care to individuals with disabilities – including physical disabilities, behavioral disabilities or intellectual disability. Very often, these are the most expensive populations, so improving outreach to them can often yield the most positive results both substantively and financially.
But perhaps most importantly, a newly reenergized state Department of Health is taking aim at health equity in a much more coordinated way as part of a larger reorganization. The new Office of Health Equity & Human Rights that will connect previously unconnected resources at the department in a manner that promises to focus on cultural competency and social determinants of health in a truly comprehensive way.
As policymakers focus more and more on these issues, it would behoove providers to do the same, as reimbursement systems, state grants and oversight increasingly take health equity issues into account. A system that generates better outcomes for diverse populations will not only benefit patients, but also providers’ own bottom lines.