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

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 

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 

* 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

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:


[See PDF for image]

[End of figure]



[1] 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).