This is the accessible text file for GAO report number GAO-03-862R entitled 'Health Care: Approaches to Address Racial and Ethnic Disparities' which was released on August 05, 2003. This text file was formatted by the U.S. General Accounting Office (GAO) to be accessible to users with visual impairments, as part of a longer term project to improve GAO products' accessibility. Every attempt has been made to maintain the structural and data integrity of the original printed product. Accessibility features, such as text descriptions of tables, consecutively numbered footnotes placed at the end of the file, and the text of agency comment letters, are provided but may not exactly duplicate the presentation or format of the printed version. The portable document format (PDF) file is an exact electronic replica of the printed version. We welcome your feedback. Please E-mail your comments regarding the contents or accessibility features of this document to Webmaster@gao.gov. This is a work of the U.S. government and is not subject to copyright protection in the United States. It may be reproduced and distributed in its entirety without further permission from GAO. Because this work may contain copyrighted images or other material, permission from the copyright holder may be necessary if you wish to reproduce this material separately. July 8, 2003: The Honorable Bill Frist: Majority Leader: United States Senate: Subject: Health Care: Approaches to Address Racial and Ethnic Disparities: Dear Senator Frist: A recent report by the Institute of Medicine, a branch of the National Academy of Sciences, found that racial and ethnic minority groups tend to receive a lower quality of health care than nonminorities, even when access-related factors such as income and insurance coverage are controlled.[Footnote 1] It concluded that the elimination of racial and ethnic health care disparities is a major challenge in the United States. Racial and ethnic minority groups identified by the federal government--American Indians or Alaska Natives, Asians, Blacks or African Americans, Hispanics or Latinos, and Native Hawaiians or other Pacific Islanders--are expected to make up an increasingly large portion of the U.S. population in coming years. The federal government, primarily through programs under the Department of Health and Human Services (HHS), plays a major role in providing and financing health care for minority groups. HHS is also the primary federal entity involved in projects and research aimed at understanding and addressing disparities in health care. HHS has focused on racial and ethnic disparities in health access and outcomes in six areas: cancer screening and management, cardiovascular disease, diabetes, HIV infection/AIDS, immunizations, and infant mortality. HHS offices and agencies, researchers at philanthropic foundations, and private organizations such as employers and health plans have efforts under way to try to address racial and ethnic disparities in health care, using interventions such as disease management programs, disease prevention programs, health literacy and language service projects, and education and outreach programs. You requested that we identify approaches that experts view as promising to address racial and ethnic disparities in health care. The enclosure contains the information we provided during our July 8, 2003, briefing of your staff. To respond to your request, we reviewed studies, journal articles, reports, and evaluations by the Institute of Medicine, federal agencies, researchers, and other organizations on racial and ethnic health care disparities and on potential: interventions to reduce disparities. We also interviewed federal officials at the Office of Personnel Management, HHS's Office of Minority Health, and six HHS agencies--the Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), Health Resources and Services Administration (HRSA), Indian Health Service (IHS), and National Institutes of Health (NIH)--to learn about their programs and initiatives. In addition, we obtained information on relevant programs, initiatives, and promising approaches to address disparities from health care researchers at academic institutions and research organizations such as the Institute of Medicine, representatives from large employers and a health plan, and officials at philanthropic foundations and other organizations. We performed our work from April through June 2003 in accordance with generally accepted government auditing standards. In brief, identifying promising approaches to address racial and ethnic disparities in health care is challenging because current efforts are in early stages of implementation, evaluations and data are limited, and information on the nonfinancial causes of health care disparities is incomplete. Experts identified the following promising approaches that the federal government could pursue to address disparities: * Develop new demonstration projects in federal programs using the best available evidence to target areas of disparities and plan promising interventions. * Expand current efforts in programs and demonstration projects such as CDC's REACH 2010 community-based coalitions. * Strengthen federal leadership on disparities, including prompt dissemination of information on successful interventions to reduce or eliminate health care disparities. * Collect complete and accurate racial and ethnic health care data in national surveys to better understand and target efforts to reduce health care disparities through steps such as ensuring the inclusion of adequate numbers of minority participants. We provided a draft of this report to officials at HHS for their technical review. We incorporated their comments as appropriate. As we agreed with your office, unless you publicly announce the contents of this report earlier, we plan no further distribution of it until 30 days from the date of this letter. We will then send copies to the Secretary of HHS, the Director of the Office of Personnel Management, and interested congressional committees and will make copies available to others upon request. The report will also be available at no charge on the GAO Web site at http://www.gao.gov. If you have any questions or need additional information, please contact me at (202) 512-7119 or Kim Yamane at (206) 287-4772. Lisa A. Lusk and Elaine Swift made key contributions to this report. Sincerely yours, Janet Heinrich: Director, Health Care--Public Health Issues: Signed by Janet Heinrich: Enclosure: [See PDF for image] [End of figure] (290284): FOOTNOTES  Brian D. Smedley, Adrienne Y. Stith, and Alan R. Nelson, eds., Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Washington, D.C.: National Academies Press, 2003).