Two recently released studies, one funded by the Robert Wood Johnson Foundation and another from the Center for American Progress, detail disparities in care along racial and ethnic lines and examine assumptions about immigrants' use of healthcare services. The Robert Wood Johnson Foundation study, which detailed hospital care for African American patients, was published in the latest issue of Archives of Internal Medicine. Conducted by a research team led by Ashish Jha, MD, MPH, Assistant Professor of Health Policy and Management at the Harvard School of Public Health, the study found that a small number of hospitals care for most elderly African American patients in America. The study showed that just 5% of American hospitals cared for nearly half of all elderly African American patients, and just 25% of hospitals cared for nearly 90% of elderly African American patients. The study also clearly showed that hospitals with high concentrations of minority patients provide modestly inferior care in pneumonia for all patients and may neglect basic services, such as providing aspirin for patients who have had heart attacks.
The study, entitled "Concentration and Quality of Hospitals That Care for Elderly Black Patients," used 2004 Medicare data to calculate the volume and proportion of African American patients discharged. The study examined the hospitals' structural characteristics and performances according to quality measures for patients with acute myocardial infarction, congestive heart failure, and pneumonia. To view the full study, visit the Archives of Internal Medicine Web site at http://archinte.ama-assn.org or http://www.rwjf.org.
A second report, entitled "Immigrants in the U.S. Health Care System: Five Myths That Misinform the American Public," which was released by the Center for American Progress, examines the idea that immigrants in the United States are a burden on the healthcare system. A decade ago this belief contributed to legislation that limited immigrants' access to healthcare. The report considers the following five assumptions:
* US public health insurance programs are overburdened with documented and undocumented immigrants
* Immigrants consume large quantities of limited healthcare resources
* Immigrants come to the United States to gain access to healthcare services
* Restricting immigrants' access to the healthcare system will not affect American citizens
* Undocumented immigrants are "free-riders" in the American healthcare system
According to the report, these assumptions feed a perception that one of the biggest reasons for the failure of the US healthcare system is the growth of immigration rather than the lack of affordable insurance and skyrocketing healthcare costs. These perceptions, in turn, have influenced healthcare policy and resulted in the 1996 passage of the Personal Responsibility and Work Opportunity Reconciliation Act, which imposed a 5-year ban on eligibility for Medicaid and other public benefits programs for recent immigrants. These same eligibility restrictions were also included in the State Children's Health Insurance Program enacted in 1997. Then, as part of the Deficit Reduction Act of 2005, applicants for Medicaid benefits were required to provide proof of US citizenship, with the intention of preventing immigrants from obtaining Medicaid coverage.
The report cites data from a range of studies on immigration and health policy to argue that preventing access to everyday healthcare only serves to worsen the situation, because noncitizens are forced to wait until health problems drive them to expensive emergency services. These attitudes also promote poor policymaking at all levels of government. The report seeks to objectively analyze these assumptions to better inform critical policy making decisions on both healthcare and immigration policy reform. A PDF of the report is available at http://www.americanprogress.org/issues/2007/06/pdf/immigrant_health_report.pdf.