Would Healthcare Have Gotten Away with Health Inequity if it Wasn’t for that Meddling Virus?

I’m a big fan of the original Scooby-Doo cartoon series, “Scooby-Doo, Where Are You!” I laugh every time I hear a variation of its now-famous episode-ending catch phrase, “I would have gotten away with it too, if it weren’t for you meddling kids!”

I thought about that line as I was reading the latest annual National Healthcare Quality and Disparities Report published by the Agency for Healthcare Research and Quality. You can download the 316-page report here. 

The report is AHRQ’s snapshot of the U.S. healthcare system taken through the lens of 233 performance measures in three domains (access to care, quality of care and disparities in care) and six subareas under the quality-of-care domain (person-centered care, patient safety, care coordination, affordable care, effective treatment and healthy living). The 2021 report is a picture of the healthcare system as it was in 2019, or a year before the COVID-19 pandemic.

As far as pictures go, this one painted a fairly rosy view of how things were going three years ago. For example, according to the report, overall:  

• Five of nine access measures improved in 2019; three stayed the same; and only one got worse
• Fourteen of 26 patient-centered care measures improved in 2019; 12 stayed the same; and zero got worse
• Eleven of 26 patient-safety measures improved in 2019; 14 stayed the same; and one got worse
• Fifteen of 35 effective-treatment measures improved in 2019; 16 stayed the same; and only four got worse
• Forty of 63 healthy-living measures improved; 20 stayed the same; and only three got worse

I’d be happy to bring that report card home to my parents.  

But not everything was perfect in AHRQ-land, particularly in the disparities domain. Compared with White Americans in 2019: 

• 84 of 195 quality measures, or 43 percent, got worse for Black Americans
• 43 of 108 quality measures, or 40 percent, got worse for American Indians and Alaska Natives
• 62 of 172 quality measures, or 36 percent, got worse for Hispanic Americans
• 48 of 173 quality measures, or 28 percent, got worse for Asian Americans
• 23 of 81 quality measures, or 28 percent, got worse for Native Hawaiians and Pacific Islanders

Not exactly a stellar performance. Our system’s rampant health disparities and glaring health inequities are there in the data in the AHRQ report for all to see. I’m pretty sure that you could pull any past AHRQ report off the shelf and find similarly unflattering pictures of our healthcare system before 2019.

Yet, health disparities and health inequity were not top of mind for most Americans and certainly not at the top of the healthcare system’s fix-it list. That is, until the COVID pandemic made it impossible to look away. We could no longer ignore the fact that the healthcare system treats people of color differently and always has. 

Would the healthcare system have continued to get away with it if the pandemic didn’t pull its hood off like Velma does to a disguised villain at the end of a Scooby-Doo episode?  I don’t know. I hope not.

Thanks for reading.