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Jon Gardner,


Economic Disparities Drive Widening Rift In
Health Care Access And Quality

Health Affairs Article: Americans Willing to Pursue Health Care Excellence For Some, While Tolerating Deterioration Of Care For Others

Bethesda, MD— As health care gobbles up an ever-larger share of the U.S. economy, the inability or unwillingness to ensure equal access to high-quality health care is fueling a widening rift between rich and poor Americans, according to a study published today as a Health Affairs Web Exclusive.

“Increasingly, America is turning into a country of health care haves and have-nots, driven primarily by the type of—or lack of—health coverage people have,” said lead author Robert E. Hurley, Ph.D., a Center for Studying Health System Change (HSC) senior consulting researcher and associate professor at Virginia Commonwealth University. HSC is a nonpartisan policy research organization funded principally by the Robert Wood Johnson Foundation.

Many recent health care investments and initiatives are focused on affluent communities and are accessible mainly to people with employer-based or Medicare coverage, while access to basic care for people with Medicaid or with no coverage at all is worsening in the wake of stalled coverage expansions and service cuts, according to the article.

The Health Affairs article, titled “A Widening Rift in Access and Quality: Growing Evidence of Economic Disparities,” is based on HSC’s 2005 site visits to twelve nationally representative communitiesBoston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. HSC has been tracking change in these markets for the past ten years.

“A clear hierarchy of access to care is emerging in many communities—there is growing evidence that U.S. society is willing to tolerate almost limitless access to care for some and deteriorating access to basic care for others,” said Hoangmai H. Pham, M.D., M.P.H., an HSC senior researcher and study coauthor, along with HSC Consulting Researcher Gary Claxton of the Kaiser Family Foundation.

Two Perspectives written by Eric Book, chief medical officer of Blue Shield of California, and Timothy Ferris and David Blumenthal of Harvard Medical School, accompany the article. Book advocates universal coverage to address coverage gaps, while Ferris and Blumenthal support strengthening safety-net providers.

The Hurley paper can be read at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.566.

The Book Perspective can be read at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.577.

The Ferris/Blumenthal Perspective can be read at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.580.

Other key findings of the study include the following:


The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org. The full text of each Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it will switch to pay-per-view for nonsubscribers. The abstracts of all articles are free in perpetuity. Web Exclusives are supported in part by a grant from the Commonwealth Fund.

©2005 Project HOPE–The People-to-People Health Foundation, Inc.