Policy Opportunities for Addressing
Child Health (& Health Care)
Disparities
Lisa Simpson, MB, BCh, MPH, FAAP
Outline
• A “look back”
• Range of possible approaches
• Three major vehicles
– CHIPRA
– ARRA (Stimulus Bill)
– Health Reform
• Some principles going forward
• Discussion
A “Look Back”
• Seemingly endless reports on disparities during
1990’s
• HP 2010 Goals include eliminating health
disparities
• IOM’s Unequal Treatment
• RWJF Commission on a Healthier America
• Role of CHSR community:
– Research as a focusing event
Research as Focusing Event
Research as Focusing Event
National Center for Minority Health and
Health Disparities; AHRQ National
Healthcare Disparities Report
Outline
• A “look back”
• Range of possible approaches
Child Health
Policy
Social
Environment
Biology
Children’s
Health
Behavior
Physical
Environment
Services
Institute of Medicine, 2004
Child Health Disparities & Policy
Opportunities
• “Traditional” health policy
– Insurance coverage, access, quality
Child Health Disparities & Policy
Opportunities
• “Traditional” health policy
– Insurance coverage, access, quality
• Welfare policy
• School policies
– School lunches, pouring contracts, PE requirements
• USDA policies
– WIC, food stamps
• Education policy
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– IEP’s, specialized services
Housing policy
Transportation policy
Tax policy
Many others
Outline
• A “look back”
• Range of possible approaches
• Three major vehicles
– CHIPRA
– ARRA (Stimulus)
– Health Reform
CHIPRA & Disparities
• The obvious
– Reducing uninsurance, improving acces
• Other
– Outreach and enrollment
– Quality measurement
• Sec. 1139A(a)(3)(D). The types of measures that, taken
together, can be used to estimate the overall national quality
of health care for children, including children with special
needs,
CHIPRA & Disparities
• The obvious
– Reducing uninsurance, improving access
• Other
– Outreach and enrollment
– Quality measurement
• Sec. 1139A(a)(3)(D). The types of measures that, taken
together, can be used to estimate the overall national quality
of health care for children, including children with special
needs, and to perform comparative analyses of pediatric
health care quality and racial, ethnic, and socioeconomic
disparities in child health and health care for children.
CHIPRA & Disparities
• Reports to Congress
– Sec. 1139A(a)(6)(A)(iii) the quality of children's health care under
such titles across the domains of quality, including clinical
quality, health care safety, family experience with health care,
health care in the most integrated setting,
CHIPRA & Disparities
• Reports to Congress
– Sec. 1139A(a)(6)(A)(iii) the quality of children's health care under
such titles across the domains of quality, including clinical
quality, health care safety, family experience with health care,
health care in the most integrated setting, and elimination of
racial, ethnic, and socioeconomic disparities in health and
health care;
CHIPRA & Disparities
• Reports to Congress
– Sec. 1139A(a)(6)(A)(iii) the quality of children's health care under
such titles across the domains of quality, including clinical
quality, health care safety, family experience with health care,
health care in the most integrated setting, and elimination of
racial, ethnic, and socioeconomic disparities in health and
health care;
• Pediatric Quality Measures Program
– Sec. 1139A(b)(3)(D) health care providers that furnish primary
health care to children and families who live in urban and rural
medically underserved communities or who are members of
CHIPRA & Disparities
• Reports to Congress
– Sec. 1139A(a)(6)(A)(iii) the quality of children's health care under
such titles across the domains of quality, including clinical
quality, health care safety, family experience with health care,
health care in the most integrated setting, and elimination of
racial, ethnic, and socioeconomic disparities in health and
health care;
• Pediatric Quality Measures Program
– Sec. 1139A(b)(3)(D) health care providers that furnish primary
health care to children and families who live in urban and rural
medically underserved communities or who are members of
distinct population sub-groups at heightened risk for poor health
outcomes;
CHIPRA & Disparities
• Obesity Demonstration - $25 M
– located in communities that are medically underserved, as
determined by the Secretary
– located in areas in which the average poverty rate is at least
150 percent or higher of the average poverty rate in the State
involved, as determined by the Secretary
• IOM Study - $1 M
– identify gaps in knowledge related to children's health status,
health disparities among subgroups of children, the effects of
social conditions on children's health status and use and
effectiveness of health care, and the relationship between child
health status and family income, family stability and
preservation, and children's school readiness and educational
achievement and attainment; …
ARRA (Stimulus Bill)
• NIH Funding ($10 B)
– Challenge Grants
• Health disparities one of 15 priority areas
• Total of 7 specific calls:
– Ethical Issues in Health Disparities and Access to Participation in
Research
– Social Determinants of Health
– Geographic Disparities in Medicare Usage and Cost
– Building trust between researchers and communities through capacity
building in Environmental Public Health
– Creating Transformational Approaches to Address Rural Health
Disparities
– Trans-disciplinary Research to Integrate the Biological and Nonbiological Determinants of Health to Address Health Disparities
– Initiating Innovative Interventions to Prevent Family Violence.
– Various other calls
ARRA (Stimulus Bill)
• Comparative Effectiveness Research ($1.1 B)
– Federal Coordinating Council
– IOM Committee
– Public Input
• Health information technology
– Policy committee to make broad range of recommendations
• technologies that address the needs of children and other
vulnerable populations
– Meaningful use definition
– Incentives and Resource Centers
• Other…
Health Reform
• Disparities specific part of President Obama campaign
platform
• Report “Health Disparities: A Case for Closing the Gap”
released June 10, 2009
– “We can no longer afford to tolerate disparities in health.”
• Emphasis on uninsurance, access, prevention, chronic
illness care.
• Health equity and Accountability Act of 2009
• Major reform bills:
– Senate HELP
– Senate Finance
– House Tri-Committee bill
Health Reform
• Concerns for children linked to future of
Medicaid/CHIP
• Disparities addressed in all
• Range of strategies:
– Establish reducing disparities as a national quality
priority
– Many quality provisions
– Focus on medical home
– Workforce and training provisions
• NHSC
• Incentives for primary care
Health Reform
• Community teams, wellness programs
• Community based public health services
• Public plan focused provisions
– Culturally and linguistically appropriate care
– Payment provisions linked to disparity reduction
• Cultural and linguistic competence
– Payment incentives
– Workforce provisions
– Emphasis on language access issues
• Data collection
Outline
• A “look back”
• Range of possible approaches
• Three major vehicles
– CHIPRA
– ARRA (Stimulus Bill)
– Health Reform
• Some possible principles
• Discussion
Some Possible Principles
• Principle 1: Inclusion of child health disparities focus
– Explicit mention of disparities in all provisions
– Explicit attention/mention of children in all disparity related
provisions
• Principle 2: Monitor progress
– Investments in data and measurement at all levels
– Use incentives for data as needed (e.g. pay for reporting)
• Principle 3: Accelerate learning
– Invest in national/regional/state based infrastructure to develop
and spread effective disparity reduction strategies
• Principle 4: Transparency
– Report annually to Congress and public on progress
Ideas
• Use existing evidence
• Think afresh on how to get healthcare to kids – e.g.
school based
• Link health indicators to school participation
• Transportation related issues in public plan, exchange,
etc
• EHR – focus on pediatric content
• Some definition of what child health is and link to risk
assessment for adults “children are different”
• Wellness and prevention – not adult
• Link of clinical with community/population health
• Issues of rural/frontier:
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Tie to non-health outcomes
Not just future value – present value
Children – pre-conception to ?
All of children’s needs across life
course/needs
• Separate analyses on children!!!!!!!!
• Focus on populations & subgroups, of
both children/providers
• Accountability entities
• Local data more than national
Discussion!
Lisa Simpson, MB, BCh, MPH, FAAP
Director, Child Policy Research Center
Professor, Department of Pediatrics
www.cincinnatichildrens.org/cprc