Map of life expectancy at birth from Global Education Project.

Tuesday, November 14, 2006

Equity and equality . . .

Not necessarily the same thing, depending on what you mean by them. I'm posting late today because I was at a forum sponsored by our state's Attorney General's office, intended for hospital managers. (I crashed it, sorta kinda, because the policy issues are up my alley.) In most states, hospitals' legitimate claim to not-for-profit status is not taken for granted. They compete, obviously, with for-profit hospitals, and they have to justify their tax exemption by establishing that they do good stuff that a for-profit hospital wouldn't necessarily do. Attorneys General monitor non-profits and issue guidelines for non-profit hospitals' so-called "community benefits," which is how they demonstrate their goodness and untaxableness.

Whoa, this was supposed to be a short story, and it's already got an expository first act. Anyhow, another thing that's going on right now in the People's Republic of Massachusetts is that we have a new requirement that hospitals report data by race and ethnicity, and that they do so according to a new standard that includes, in addition to the Five Official Races and the One Official Ethnicity, a full menu of ethnicities, from Brazilian to Bosnian. Good. The seminar was on how to use this wonderful data to fulfill the community benefits requirement -- which pretty much came down to identifying and working to eliminate racial and ethnic disparities in health care. Which they are going to want to do because our new health care reform legislation, starting in 2008, is going to tie their reimbursement rates to as-yet-to-be-defined progress in reducing disparities.

I'll talk more about the whole community benefits thing, and the problems of measuring disparities in health care, and all that, another time. Today I just want to pick up on a snippet of today's conversation. One presenter mentioned that when she goes to talk to groups of doctors about health care disparities, they'll say, "Other providers may have a problem, but I treat everybody the same."

Here's my answer to that, which I also hear all the time.

That's your problem. You treat everybody the same (or at least you think you do), but everybody is not the same. In fact, everybody is different. Differences in language, culture, level of formal education, life experience and circumstances, all directly effect communication, decision making, adherence to your advice, understanding what you say, you understanding what they say, making the correct diagnosis, offering the right treatment -- and they require that you treat people, not the same, but rather equally appropriately, according to their specific needs and resources. If you treat everybody the same, as a health care provider, you are discriminating, in favor of people who are most like you, with whom you communicate with the least difficulty. Think about it.

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