A new set of strategies released by the Commonwealth Fund Commission on a High Performance Health System could dramatically improve how the U.S. health care system serves vulnerable populations -- those in the U.S. who are uninsured, low-income, or members of racial and ethnic minority groups.
According to the new report, Ensuring Equity: A Post-Reform Framework to Achieve High Performance Health Care for Vulnerable Populations, closing the health care divide will require a three-pronged policy framework that ensures adequate access to health care and financial protection, strengthens the health care system's ability to serve vulnerable populations, and supports coordination between the traditional health care system and the resources outside of the health care system that vulnerable groups rely upon.
The report highlights the significant divide between vulnerable populations and their more secure counterparts in rates of receiving recommended screening and preventive care, control of chronic diseases, and hospital admissions for conditions that may be preventable with good primary care and community health outreach. For example:
"Our current economic situation has increased the number and proportion of people who are vulnerable, leaving even more families at risk of suffering from our health care system's inequities," said Commission Chair David Blumenthal, M.D., Samuel O. Thier Professor of Medicine and Professor of Health Care Policy at Massachusetts General Hospital/Partners HealthCare System and Harvard Medical School. "The recommendations in this report can encourage policymakers to focus on the unique issues facing these populations, and work toward creating a high performance health system for all."
The authors note that Affordable Care Act provisions targeted at vulnerable populations will go a long way toward improving health care for these groups, primarily through expanded health insurance, increased financial support for community health centers, and reforms that should improve health care quality and allow for people in vulnerable groups to receive better coordinated health care. However, vulnerable groups will remain at risk for poor health outcomes unless crucial issues beyond health insurance coverage like access to health care, affordability, care coordination, and the financial stability of safety-net hospitals are addressed.
A Policy Framework for Vulnerable Populations
In the report, the 17-member Commission lays out a policy framework that builds on Affordable Care Act reforms to create a more equitable health care system. The Commission comprises experts and leaders representing every sector of health care, as well as the state and federal policy arena, the business sector, professional societies, and academia.
The framework's overarching strategies revolve around ensuring adequate access and financial protection, strengthening the care delivery systems serving vulnerable populations, and coordinating the traditional health care system with outside resources also affecting vulnerable groups. Highlights of the framework include:
"This policy framework builds on the great strides we expect to be made for vulnerable populations once the Affordable Care Act takes full effect in 2014," said Commonwealth Fund Executive Vice President for Programs Anthony Shih, M.D. "By addressing crucial issues like access to care, affordability, quality improvement, and better coordinated care, these recommendations seek to assure that the uninsured, those with low incomes, and racial and ethnic minorities see the full promise of health reform and experience a truly equitable health care system."
"The Affordable Care Act is a big step forward in terms of addressing the significant needs of vulnerable groups and the health care providers who serve them," said Commonwealth Fund President Karen Davis. "However, the inequity in our health care system is significant and -- as laid out in the Commission's new report -- more work must be done in order to close that gap and assure that we have a health care system that provides all of us with access to high quality health care."
Materials provided by Commonwealth Fund. Note: Content may be edited for style and length.
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