[PA-36] The Bronx Health REACH
Neil Calman, MD, Institute for Urban Family Health, New York, NY
Problem: Racial disparities in health outcome are built into the way health care is financed, organized and delivered in the United States.
Background: The Bronx Health REACH includes 13 community-based and 14 faith-based organizations. The group conducted a literature review and a series of focus groups on racial disparities in health outcomes, and developed an action plan focused on education, prevention, changing the health care system, and legal and regulatory changes that promote equal access to care.
Method: The legal and regulatory work-group has performed a literature review and a survey of academic medical institutions in New York City to investigate issues that impact on disparities in health. These issues include the way in which health care providers make clinical decisions when they treat people of color, the way institutions organize and deliver health care, and the way government legislation and regulation control the delivery of care through financing mechanisms.
Results: The work confirms that the differential in insurance payments has caused academic medical institutions to create disparate systems of care (ie: faculty practices for those with Medicare and private insurance, and clinics for those on Medicaid or who are uninsured.) These practice environments differ greatly in the quality of care provided. Since people of color are disproportionately represented in Medicaid and other public programs, this effectively constitutes de facto racial discrimination, secondary to discrimination based on insurance status. However, this is not a protected class in Title VI of the Civil Rights Act.
Conclusion: The group has concluded that the two-tiered system of care is at least partially the result of disparities in financing and that the regulations that permit this must be challenged.
