Barack Obama in 2008 promised to tackle inequality in health care — with data.
He said his administration would "challenge the medical system" by "requiring hospitals and health plans to collect, analyze and report health care quality for disparity populations and holding them accountable for any differences found."
"Disparity" is the industry shorthand for health differences between groups linked to disadvantage. For example, racial and ethnic minorities are less likely to get preventive care, more likely to face serious illness, and less likely to get quality health care when they do, according to the Health and Human Services Department.
Two signature pieces of legislation, the American Recovery and Reinvestment Act and the Affordable Care Act — better known as the stimulus and Obamacare — include a range of measures to move toward data-based accountability for hospitals.
But progress is less certain for health plans, whose main regulator is not the government but a private nonprofit, the National Committee for Quality Assurance.
"I believe most people working in health policy who are interested in disparities would say so far so good, but we still need see what happens," said Thomas LaVeist, director of the Hopkins Center for Health Disparities at the Johns Hopkins Bloomberg School of Public Health.
Action under the Recovery Act and Affordable Care Act includes:
• Implementation of electronic medical records, with bonus payments for "meaningful use" that require data collection by race, ethnicity and language proficiency, which LaVeist calls "vital" for holding hospitals accountable.
• Medicare's eventual move to "value-based" reimbursement, which bases payments on quality measures.
• New standards for health data collection. All health surveys sponsored by the Health and Human Services Department now must include standardized information on race, ethnicity, sex, primary language and disability status.
Most provisions to strengthen data collection on health disparities focus on government-funded surveys, not hospitals or health plans. Meanwhile, accountability is enforced primarily through Medicare payments to hospitals. The administration's action plan to reduce health disparities does call for incentives to reduce disparities for health plans participating in new health insurance exchanges, but rules for such exchanges will vary by state and don't include large employer-based plans.
It's clear that Obama has made significant progress on this promise, largely through the health care law and economic stimulus. However, we find the incentive-based approaches fall short of "requiring" hospitals and health plans to collect the data. So we rate this a Compromise.