What can radiology do to address disparities and promote equity in health care? There are a number of ways the specialty can take action to even the playing field, according to presenters of a Wednesday session.
Carlos
Increasingly, it is recognized that social determinants connected with health care play a large role in health outcomes, said Ruth Carlos, MD, MS, professor of radiology, University of Michigan, Ann Arbor, during the Special Interest Session, "A Call to Action in Health Equity: An Interactive Session on Health Disparities and Health Equity in Radiology."
For example, the type of neighborhood a person lives in can impact health care in numerous ways. As the pandemic illustrated, maintaining safe distances and protecting at-risk family members is a challenge in high-density urban areas and in multigenerational housing. Safety may be a concern in such neighborhoods.
And often, those who live in high-density neighborhoods work in similar packed work environments (such as an Amazon fulfillment center, for example) on zero-hour contracts with no sick leave or employer insurance.
"All of which leaves families financially fragile," Dr. Carlos said.
Dr. Carlos also emphasized that the social determinants of health and the financial burden patients may face are not necessarily race-based.
"Studying social determinants of health tells us that it is not always biology that determines destiny – it may be a ZIP code," she said. "The impact of lower social determinants of health are more prevalent among self-identified African Americans and Hispanics, but what we may be attributing to race may in fact be due to their ZIP code."
Access to Care – Or Lack of It
In his presentation Richard Heller III, MD, MBA, associate chief medical officer: Communications & Health Policy, and national director of Pediatric Radiology, Radiology Partners, Chicago, echoed Dr. Carlos in describing ZIP code as a better predictor of health than a person's genetic code. Where someone lives also plays a key role in access to care – or lack of it.
Heller
"America has a fantastic health care system, if you can access it," Dr. Heller said,
Dr. Heller suggested the American healthcare payment system has exacerbated the problem of access to care. He referenced a recent study by MACPAC (the Medicaid and CHIP Payment and Access Commission) showing that a private payor will pay twice what Medicare pays for hospital services, while at the other end of the spectrum, Medicaid will pay a fraction of what Medicare pays.
These differences are reflected in access to care. "The lower the payment the worse the access," Dr. Heller said. For example, the same MACPAC study showed that just 70% of providers accepted Medicaid and just 36% of psychiatrists accepted new Medicaid patients.
How Can Radiology Help?
Other than improving the rates of public payors, what can radiology do to confront these barriers to care? Drs. Carlos and Heller say radiologists can take action on a number of fronts.
Dr. Carlos suggests screening for financial fragility in the outpatient imaging setting by asking patients a few simple questions.
"We also need to change our research perspective to evaluate the effects of racism or gender bias, take ownership for the financial distress we cause our patients, and work to decrease financial distress by managing overdiagnosis and overtreatment," Dr. Carlos said.
And radiology can make a difference in terms of providing value for service, Dr. Heller said.
"If someone thinks of health care as a limited resource – like the environment – we want to be protective of that resource, and not waste it," he said. "So how can radiology promote good stewardship of our health resources?"
One answer: Limit unnecessary downstream costs, something radiology is well-positioned to do since so much of healthcare flows through radiology.
"We exist in radiology at the fulcrum of healthcare," Dr. Heller explained. "Whether it is a screening, diagnostic, therapeutic or follow-up examinations, all of these flow through radiology. This means that radiology has a tremendous impact on what happens 'downstream'."
Which do you think are the most problematic factors affecting access to care? To learn more about this topic, check out SPSI24: Special Interest Session: A Call to Action in Health Equity: An Interactive Session on Health Disparities and Health Equity in Radiology. #RSNA20
— RSNA (@RSNA) December 2, 2020
For More Information:
View the RSNA 2020 session A Call to Action in Health Equity: An Interactive Session on Health Disparities and Health Equity in Radiology — SPS124 at RSNA2020.RSNA.org.
