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Disparities in Health Care within Groups is More Relevant than Disparity Gaps between Groups
Comparing inequalities in health care with respect to a threshold level of health care matters as much if not more than health care disparity gaps between groups, wrote Jennifer Prah Ruger, Ph.D., in an editorial published in this month’s British Medical Journal. Referring to a recent study that was conducted using the variation in rates at which those in different demographic subgroups received medical care, Ruger, an assistant professor of public health at the Yale School of Public Health, wrote that “when a technical process quality measure was used, the overall score for quality of care was higher for black and Hispanic people than for white people.” These findings differ from previously conducted studies showing that women, minorities, the uninsured, the elderly, the poor and the uneducated, are less likely to receive proper medical care. “Measuring health care disparities from a shortfall rather than an inter-group perspective selects a threshold or standard below which health performance is judged to be inequitable,” remarked Ruger. “An example of a threshold might be achieving 100% immunization coverage for all children.” Ruger refers to using the method of shortfall inequality to measure health care disparities. Typically used in welfare economic studies, shortfall has just evolved in the health profession. Dr. Ruger has forthcoming publications in the fall that detail the theoretical basis of her shortfall method and study it empirically. Comparing groups to one another without examining the inequities within, she writes “disregards the optimal quality of care and standards of good practice.” |
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