Improving Care and Outcomes of Uninsured Persons with Chronic Disease … Now

Chronic disease kills, and uninsured persons with chronic disease are particularly vulnerable to poor outcomes. In this issue, Wilper and colleagues (1) report that an estimated 11.4 million working-age Americans with cardiovascular disease, hypertension, diabetes, hypercholesterolemia, pulmonary disease, and cancer do not have health insurance.

The usual clarion call about the uninsured is to expand access to insurance. Health care insurance reform is necessary for good care for chronic disease, but it will not be sufficient unless it is coupled with quality improvement efforts targeting the reasons that vulnerable populations with access to care often do not receive optimal care. I outline what every practice, every hospital, and every health plan can do now to improve outcomes for vulnerable patients with chronic disease and identify opportunities for policy reforms.

1. Examine your own performance data, stratified by insurance status, race and ethnicity, language, and socioeconomic status. Health care is local. Organizations and providers must be convinced that a local problem exists before they will take action. Eighty-eight percent of providers recognize that racial disparities in care exist nationally, but only 40% believe that they are present in their practice (2). Most providers and organizations become disturbed and motivated when they find that their own patients are experiencing disparities in their care. A hard look at one's own data is the first step toward effective action.

2. Get training for you and your staff to work effectively with diverse populations. Members of racial or ethnic minority groups are more likely than white persons to perceive that medical staff judge them unfairly or treat them with disrespect and to believe that they would receive better care if they were of a different racial or ethnic group (3). Overt racism by providers, such as a conscious effort …