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Policy Perspectives
May 17, 2000

Inequality in Quality: Addressing Socioeconomic, Racial, and Ethnic Disparities in Health Care

Author Affiliations

Author Affiliations: Departments of Family Medicine (Drs Fiscella and Franks) and Community and Preventive Medicine (Dr Fiscella), University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Community Health and Social Medicine, City University of New York Medical School, New York, NY (Dr Gold); and Agency for Healthcare Research and Quality, Rockville, Md (Dr Clancy).


Policy Perspectives Section Editors: Robert J. Blendon, ScD, Harvard School of Public Health, Boston, Mass; Drummond Rennie, MD, Deputy Editor, JAMA.

JAMA. 2000;283(19):2579-2584. doi:10.1001/jama.283.19.2579

Socioeconomic and racial/ethnic disparities in health care quality have been extensively documented. Recently, the elimination of disparities in health care has become the focus of a national initiative. Yet, there is little effort to monitor and address disparities in health care through organizational quality improvement. After reviewing literature on disparities in health care, we discuss the limitations in existing quality assessment for identifying and addressing these disparities. We propose 5 principles to address these disparities through modifications in quality performance measures: disparities represent a significant quality problem; current data collection efforts are inadequate to identify and address disparities; clinical performance measures should be stratified by race/ethnicity and socioeconomic position for public reporting; population-wide monitoring should incorporate adjustment for race/ethnicity and socioeconomic position; and strategies to adjust payment for race/ethnicity and socioeconomic position should be considered to reflect the known effects of both on morbidity.

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