It’s no secret that African-Americans have faced health disparities since they were considered citizens of this country. Not only have Black communities seen a lack of medical support, but when received, sometimes backfired on them and caused an immense amount of distrust between both the respective communities.
Recently the COVID-19 pandemic highlighted the lack of care, support, and health equity people of color received from doctors and hospitals.
Health expert Amol Navathe recently discussed how structural racism and value-based payment programs which tie payments to quality and cost can inadvertently lead doctors to avoid patients who are more likely to be dealing with higher rates of chronic illness and social and economic challenges that make it harder for them to achieve good health outcomes.
Navathe is an associate professor of health policy and medicine at the Perelman School of Medicine at the University of Pennsylvania and a commissioner of the Medicare Payment Advisory Commission (MedPAC), a non-partisan agency that advises Congress on Medicare policy.
“Health care payment is a complicated system because there are many different factors that play a role in it,” Navathe said. “The first thing physicians look at is the type of insurance the patient has. If the patient has private or government insurance, the hospitals typically are paid more for tending to that patient. Whereas if the patient has Medicare or Medicaid, the hospitals or physicians know the payment is lower and the patient will less likely be taken seriously toward their health issues.”
Low-income families and minority communities find it difficult to find suitable healthcare centers around them because of the types of insurance they can afford. If these families do not have state or government insurance through their job, they’re forced to have low-cost insurance that doesn’t provide the same level of access as their wealthy counterparts.
Navathe noted that a value-based healthcare payment system is a popular solution for many, but value does not equal equity.
While the benefits of value-based payments and making medical care centers more accountable may look like the silver bullet for our health care system, Navathe said it is not.
“My studies and research showed that the value of the dollar spent in healthcare does not equal equity,” he said. “The value-based payment models have shown to harm equity, which harms low-income patients.”
During his PowerPoint presentation, Navathe demonstrated how the value-based payment model puts a greater financial risk on hospitals and physicians, which have not had positive outcomes.
The result of the payment model is that many physicians and hospitals may avoid marginalized patients, who participate in the value-based payment model, which adds to the disparities in health care.
It’s not all doom and gloom, Navathe said. value-based payment models can align with health equity goals.
“We need to make an intentional policy about achieving equity and be willing to put dollars and resources behind it,” Navathe said, pointing to positive steps to address health equity such as the Pennsylvania Rural Health Model. Under this program, Medicare pays participating rural hospitals a fixed amount in advance to cover all inpatient and hospital-based outpatient services. Medicare has also created Accountable Care Organization (ACO) models designed to advance health equity in underserved communities.
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