Health care system

Health systems leaders from across U.S. detail health equity initiatives

As the COVID-19 pandemic exacerbated existing health equities, health systems nationwide have implemented a series of initiatives to reduce disparities (Source: “13 leaders on health equity initiatives launched in the last year,” Becker Hospital Review). 

Leaders from 13 health systems from across the country answered a series of questions on their health equity initiatives and shared lessons learned so far with editors of Becker Hospital Review.


100 million Americans have medical debt, study finds

More than 100 million people in America ― including 41% of adults ― are carrying medical debt, according to an investigation by KHN and NPR (source: “100 million people in America are saddled with health care debt,” Kaiser Health News via Ohio Capital Journal, June 21).

The investigation reveals a problem that, despite new attention from the White House and Congress, is far more pervasive than previously reported. That is because much of the debt that patients accrue is hidden as credit card balances, loans from family, or payment plans to hospitals and other medical providers.

To calculate the true extent and burden of this debt, the KHN-NPR investigation draws on a nationwide poll conducted by KFF for this project.

In the past five years, more than half of U.S. adults report they’ve gone into debt because of medical or dental bills, the KFF poll found. A quarter of adults with health care debt owe more than $5,000. And about 1 in 5 with any amount of debt said they don’t expect to ever pay it off.

Nationwide, according to the poll, Black adults are 50% more likely and Hispanic adults are 35% more likely than whites to owe money for care.


Hospitals move to address nursing staff burnout

One-third of nurses in the United States plan to leave their jobs by the end of the year and another 20% plan to leave the industry altogether, according to two new surveys  (Source: “How to curb nurse burnout? Hospitals adding job flexibility to stem staff shortages,” Cincinnati Enquirer, May 9).

The reasons are largely due to the incessant burnout, stress, and fatigue that nurses have experienced during the COVID-19 pandemic. But other factors include financial considerations and a perceived lack of flexibility in the industry as well as too few advancement opportunities. 

In response, hospitals are beginning to look inward at how to retain talent and alleviate burnout, particularly among nursing staff as shortages stretch into the foreseeable future. Health systems are pivoting to accommodate the changing needs of nurses.


Black, unmarried patients more likely to have negative descriptors in health records, study finds

The language clinicians use in their electronic health record (EHR) notes varies by patients' race, marital status and type of insurance, according to a new study (Source: “Patients who are Black, unmarried or on government insurance described more negatively in EHR, study shows,” Jan. 19).

The Health Affairs study found Black patients were 2.54 times more likely to have one or more negative descriptors in their EHR notes than white patients. It also found patients who are unmarried or enrolled in a government insurance program had higher likelihoods of negative descriptors than patients who were married or enrolled in private or employer-based insurance plans. 

The study's authors said their findings raise concerns about racial bias in healthcare and the possible transmission of stigma through the EHR. They said providers may need self-awareness and bias training to change their language.


Ohio COVID hospitalizations triple this time last year, ODH director says

The Delta variant is continuing to drive an increase in COVID-19 cases and hospitalizations with the number of hospitalizations reported Wednesday in Ohio nearly triple the amount reported a year ago, Ohio Department of Health Director Dr. Bruce Vanderhoff said Thursday (Source: “Ohio’s daily COVID hospitalizations nearly triple vs. year ago, Vanderhoff says,” Dayton Daily News, Sept. 16).

On Wednesday, ODH reported 7,747 new daily cases of COVID and 292 daily hospitalizations. A year ago, on Sept. 15, 2020, the state reported just over 1,000 daily cases and 103 hospitalizations, he said.

“Even though about half of us today are well protected by vaccination, our daily hospitalizations are about triple what they were last year,” Vanderhoff said. “And the reason is simple. The Delta variant is aggressively seeking out anyone who lacks immunity and is making many of them very sick.”


U.S. health system ranks at bottom among high-income nations, study finds

The United States has the worst health-care system overall among 11 high-income countries, even though it spends the highest proportion of its gross domestic product on health care, according to a new report (Source: “U.S. health-care system ranks last among 11 high-income countries, researchers say,” Washington Post, Aug. 5).

The Commonwealth Fund research compared the healthcare systems of 11 high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. The study relies on 71 performance measures, based on surveys conducted in each country and administrative data from the Organization for Economic Cooperation and Development and the World Health Organization. The measures analyzed fell under five themes: access to care, the care process, administrative efficiency, equity and healthcare outcomes.

Norway, the Netherlands and Australia were the top-performing countries overall. The high performers stand apart from the United States in providing universal coverage and removing cost barriers, investing in primary care systems to reduce inequities, minimizing administrative burdens, and investing in social services among children and working-age adults, the Commonwealth Fund found.


Organizations aim to connect patients, therapists of color

A number of new organizations aim to digitally connect patients with mental health providers who value and understand different cultures (Source: “It’s Hard to Search for a Therapist of Color. These Websites Want to Change That.,” New York Times, July 16).

In recent years there has been an expanding number of digital companies and nonprofits created to help people of color find a therapist they can trust — someone who is not only skilled in the best evidence-based treatments but also culturally competent. In other words, a provider who is aware of their own world views, knowledgeable about diversity and trained to connect with different types of clients.

The founders of these organizations say there has always been a need for such services, and even more so now that people are coping with the stressors of the pandemic and the racial reckoning that followed the killing of George Floyd by the Minneapolis police.

Studies have shown that mental health treatments can be more effective when a client feels that their therapist values culture.

It can be difficult for people of color to locate a therapist with a shared cultural background.  An American Psychological Association report found that only 5% of psychologists are Hispanic and 4% are Black — 86% are white. A similar disparity exists among the country’s social workers and psychiatrists.


Low number of Black dermatologists could hurt quality of care, providers warn

For people of color, basic dermatological conditions sometimes go undiagnosed or misdiagnosed by doctors unfamiliar with treating darker skin, healthcare professionals say (Source: “Skin color matters: In dermatology, patients' diversity calls more Black doctors,” Columbus Dispatch, July 29).

According to a June 2017 study published in the Dermatology Journal of the American Medical Association, 3% of dermatologists in the United States were Black. In 2020, 13.4% of the U.S. population was Black or African American, according to the U.S. Census.

A lack of diversity in any medical field can hurt the quality of care given. And a doctor from one ethnic or racial background might be able to offer information not necessarily taught in school.


States reluctant to target hospital costs in employee health plans, new study finds

Hospital prices are cited most frequently by state plans as their top cost driver, but state negotiators are more likely to target other forms of health care spending when it comes to curbing costs, a new study found  (Source: “States don't want to tackle high hospital costs,” Axios, June 17)

According to a new study by Georgetown's Center on Health Insurance Reforms, state health plan administrators are “fully aware that hospital prices are the primary driver of the steady increase in the cost of employee health benefits. Yet they remain focused on secondary drivers such as excessive or inappropriate utilization.”

State employee health plans are often the largest employer purchasing insurance in their state, so in theory, should have significant clout when negotiating prices. But according to the report, plan administrators say it is hard to go after these prices because of a lack of competition between hospitals, hospitals' political clout and employee pressure to keep broad provider networks.


New tool tracks health disparities in U.S.

A coalition of researchers and advocates launched a tool this week they hope will fill some of the gaps in data on racial disparities in the U.S. health system (Source: “A new tool tracks health disparities in the U.S. — and highlights major data gaps,” Stat News, May 26).

The Health Equity Tracker is a portal that collects, analyzes and makes visible data on some of the inequities entrenched in U.S. medicine.

“For far too long it’s been ‘no data, no problem,’” said Nelson Dunlap, chief of staff at the Satcher Health Leadership Institute at Morehouse School of Medicine, which developed the tool with funding and resources from Google.org, Gilead Sciences, Annie E. Casey Foundation and CDC Foundation.

By making data accessible that highlights racial health disparities, the tracker aims to empower local advocates to drive change in their communities — and inspire action to fill in holes in data that are themselves reinforced by structural racism. In the tracker’s display, 38% of federally-collected COVID-19 cases report unknown race and ethnicity.