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Collecting, Using, and Disseminating Health Data on Minority Populations
Access to Health Care Services
Presenters:
Robin M. Weinick, Ph.D., Director, Intramural Research, Center for Primary Care Research, Agency for Healthcare Research and Quality (AHRQ).
Patricia M. Golden, M.P.H., former Special Assistant for Minority Health Data, Division of Analysis, Epidemiology and Health Promotion, National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC).
Linda Yu Bien, M.S.P.H., Executive Vice President and Chief Operating Officer of North East Medical Services (NEMS), San Francisco, CA.
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This session described how racial and ethnic minority populations access the health care system and how well the system serves these
populations. Strategies for overcoming the challenges of collecting data related to accessibility and quality of health care services for minority
populations were discussed. This session also highlighted several major data sources that can be used to examine access to health care.
Robin Weinick presented a framework for thinking
about access to health care services. The framework consists of six major components to consider in determining how one gets the
necessary care in order to produce good health outcomes. She described the measures associated with each component and provided
examples of related research on disparities in access to care. The major components include:
- Health insurance coverage.
- Access to care.
- Access to health and health care information.
- Utilization.
- Quality of care.
- Discrimination, language, trust, and acculturation.
She also listed some of the AHRQ data sources available for studying disparities, including:
As a part of AHRQ's 1999 reauthorization legislation, the Agency is required to submit an annual report to Congress regarding disparities in
health care delivery as it relates to racial factors and socio-economic factors in priority populations. The first National Health Care Quality
report is due in fiscal year 2003.
Patricia Golden discussed the types of race and ethnicity data available from the Centers for Medicare and Medicaid Services (CMS). CMS
data provides information on the use of services paid for by CMS and the cost of these services. Technical assistance is available to help in
the access and analysis of CMS data through the CMS Research Data Assistance Center (ResDAC).
Of the many Medicare data sources available, Golden recommends the Medicare Current Beneficiary Survey (MCBS) for data analysis on
racial and ethnic populations. MCBS represents the entire Medicare beneficiary population, including demographic and socio-economic
variables, and includes all health care services and expenditures.
Medicaid data sources include State Medicaid Research Files (SMRF) and the Medicaid Statistical Information System (MSIS). The MSIS
was developed to collect, manage, analyze and disseminate information on eligibles, recipients, utilization, and payment for services covered
by State Medicaid programs. Golden noted that the quality of Medicaid data varies greatly across states.
In addition to CMS data, Golden explained there are several other data sources available to address access to care issues:
- National Health Interview Survey (NHIS).
- National Health Care Survey—Provides a wide range of data on the health care field, including utilization, medical technology and quality of
care.
- U.S. Census 2000 data—Provides population and housing data for every housing unit in the U.S. in 2000.
- U.S. Census Current Population Surveys—Provides up-to-date information on social, economic, and demographic characteristics of
Americans.
Linda Yu Bien discussed the Health Services and Resources Administration (HRSA) Uniform Data System (UDS). NEMS is the largest
community health center (CHC) serving the Asian population. Bien explained that the UDS, administered by HRSA's Bureau of Primary Health
Care (BPHC), is an integrated reporting system used by all grantees, including CHCs.
The UDS provides aggregate data, collected annually, on CHCs
and users that can be analyzed to determine information on CHC and user characteristics, financing and revenues, encounters, and staffing. UDS
captures many racial and ethnic classifications and asks CHCs the language needs of the patient population they serve. This information is important
in identifying the health care services the community needs and services that may be particularly beneficial to a specific race or ethnic population.
Additional Resources
Bureau of Primary Health Care. Uniform Data System Background Information. Health Resources and Services Administration. Jan. 2002.
http://www.bphc.hrsa.gov/uds
Bureau of Primary Health Care. Uniform Data System Manual, 2001 Revision. Excerpt. Health Resources and Services Administration
Kaiser Commission on Medicaid and the Uninsured. Health Insurance Coverage and Access to Care Among American Indians and Alaska Natives. Fact Sheet. Jun. 2000. http://www.kff.org/content/2000/1525/American%20Indians.pdf
Kaiser Commission on Medicaid and the Uninsured. Health Insurance Coverage and Access to Care Among Asian Americans and Pacific
Islanders. Fact Sheet. Jun. 2000. http://www.kff.org/content/2000/1525/Asian%20Americans.pdf
Kaiser Commission on Medicaid and the Uninsured. Health Insurance Coverage and Access to Care Among Latinos. Fact Sheet. Jun. 2000. http://www.kff.org/content/2000/1525/Latinos.pdf
Kaiser Commission on Medicaid and the Uninsured. Health Insurance Coverage and Access to Care Among African Americans. Fact Sheet. Jun.
2000. http://www.kff.org/content/2000/1525/African%20Americans.pdf
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