In order to decrease disparities of care to minorities or those that are of different cultural heritage, the medical profession needs to learn cultural competency.
Using the Internet find resources regarding cultural competency.
Write a 500-750-word paper on your findings on cultural competency. Be sure to address the following:
1.Define cultural competency.
2.What are the top barriers identified to address in cultural competency?
3.Would you mandate it be included in school curriculum?
4.Why is it important, or not, for the health care profession to be aware of cultural competency?
5.As a professional, what is the biggest difference you could make by practicing cultural competency?
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located on the Student Success Center. An abstract is required.
Trends and Issues for the 21st Century
Health care trends and issues are well documented by multiple governmental and private organizations to study changes in the demographics of the populations, to discover disparities in health care, and to develop consistent solutions to any problems exposed. Changing population age, ethnic minority shifts, and economic swings do not alter the basic need for adequate health care and developing sustainable programs to adjust to future needs. The health of the nation is at risk without solutions in place.
Factors in Disparities
Disparities in health care quality and access have been extensively studied by The National Center for Health Statistics for the purpose of discovering trends and directing policy to improve the health of the nation (Centers for Disease Control and Prevention, 2008). The U.S. Department of Health and Human Services, through the Agency for Healthcare Research and Quality (AHRQ) has as its mission to improve the quality of health care for all Americans by identifying inequalities in care (Agency for Healthcare Research and Quality, 2004). A research search finds other agencies address the same basic disparity issues in health care.
The aging population of the United States creates new problems with an increased need for more access to health care. The Centers for Medicare and Medicaid Service (CMS), report that in 2006 there were 35.5 million people over the age of 65 in the United States. This is expected to rise to 55 million by 2020 (The Centers for Medicare and Medicaid Service, 2006) As people are living longer, the incidence of chronic diseases increase the need to utilize the health care system, increase the cost of and usage of medications, and an overall increase in the size of the health care budget (Lecca, Valentine, & Lyons, 2003, p.176). Utilizing the budget for the elderly takes money from other programs needed to be financed. The governmental Medicare and Medicaid systems provide coverage for the elderly and disabled, but struggle to keep access to adequate care available.
The Centers for Medicare and Medicaid Service (CMS) report states that in 2006 the expenditures for Medicare and Medicaid were estimated to be 3.2% of the gross domestic budget (GDB). The government realizes that costs need to be controlled and pass the Medicare Modernization Act to identify and put in place cost-cutting solutions to help the Medicare system survive (The Centers for Medicare and Medicaid Service, 2006). Without the programs many more elderly Americans would have no insurance coverage and only increase the disparity to adequate health care.
Changing minority and ethnic populations in the United States presents unique challenges to health care delivery. The demographics in the United States have changed to a more ethnically diverse population, which has forced health care providers to reevaluate the health care delivery system and those that deliver the care. Lecca et al. (2003) suggest that more cross-cultural programs be developed to meet the needs of minorities.
The Institute of Medicine commissioned a study on health disparities in minority populations. In its 2002 report Unequal Treatment: What Healthcare Providers Need toKnow About Racial and Ethic Disparities in Healthcare, The Institute of Medicine suggested that health professionals should be educated on attitudes, knowledge base, and skills to better understand another culture in order to deliver effective health care. Only through education and understanding will the racial and ethnic barriers be eliminated to decrease disparities in care.
The U.S. Census Bureau reports that in 2007 the minority population numbered over 100 million. This translates to one in three people living in the United States being classified as a minority (U.S. Census Bureau, 2007). Blacks, Hispanics, Asians, American Indian, Alaska Native, and Native Hawaiian are all listed as minority groups, with non-Hispanic, single race representing 66% of the population. With such large numbers of the population listed as minorities, health care concerns must be addressed.
Disparities in health care often include a lack of insurance or financial means to pay for care. Those that qualify can enroll in governmental programs to pay for their care, but others find it difficult to afford even basic health needs. Disparities in health care can also include locations where access is limited, as rural areas that have either no health care providers available or lack of transportation to get to where the care is provided. Persons with diseases that require specialized treatments may need to access health systems that are far from their homes and have few care options to consider (Shi & Singh, 2003).
Quality of Care
Access to health care providers is just one aspect of receiving adequate health care. One of the requisites of good health care is delivering it in an equable manner, no matter which racial background, location of care, or economic status of the patient (Mead, Cartwright-Smith, Jones, Ramos, Woods, & Siegel, 2008). Quality of care issues includes practicing in a facility that has been properly licensed, staffed with knowledgeable professionals, and has achieved good outcomes, no matter which patient population is being served (Shi & Singh, 2003).
Quality of care issues result from behaviors displayed by both the providers of care and the receivers of care. It has been shown that there is an inequity in treatment plans for both disease management and routine care from the providers. Many providers are not aware of the cultural issues and plan their treatments on biased information. Many times language is a barrier to effective treatments that can delay care and result in a worsening condition (Mead et al., 2008, pp. 61-65).
Providers can be more effective in their care of minorities by following the recommendations of the American Medical Association (AMA) and other organizations to increase knowledge regarding the minority populations and not rely on past experiences (American Medical Association, 2008). The Center for Health Equity Research and Promotion recommended that providers increase cultural competency to decrease health care disparities for their patients, whatever their cultural or economic situation (Thompson, 2007). As the population of minorities grows, the importance of effective communication with patients is key to healthy outcomes.
Minorities also affect their quality of health care. Cultural and socioeconomic beliefs can delay seeking medical care until conditions worsen and options are limited. Language barriers limit receiving both health care information and the correct information to make informed decisions. Minorities may distrust providers and either fail to seek treatment or reject the treatment options given. Quality of care can also be affected by the location care is received. Minorities often go to community clinics or emergency departments for treatment of acute episodes of illness and never establish care with a primary provider for a more consistent treatment plan, which can provide wellness programs (Mead et al., 2008).
Qualities of care issues are often hard to measure. The financial systems that pay the bills for patient care are always researching ways to keep the quality care, but limiting the costs of delivering that care. Outcomes of disease management or routine care can vary depending on the provider of that care. Over the years several methods have been put in place to establish treatment plans and best practice guidelines to achieve the best patient outcomes in the most cost-efficient way.
Clinical Guidelines are evidence-based treatments that have been established to be the best options to care. Clinical Pathways are designed for a multidisciplinary collaboration for patient treatments. They specify the outcomes for “… guidance for each stage in the management of a patient…” (Open Clinical, 2003). Each gives details on how patient care should be directed. In the health care industry, which is comprised of multiple levels of professionals that come from different educational backgrounds, each can improve quality of care by decreasing the disparity of care and work from the same plan of action.
Health Care for the Future
Health care in the future, as in the present, must first concentrate on the financial or payer source in order to make changes. Governmental and private insurance payers must find ways in which to cut costs while delivering care. Insurance coverage and payment options have shifted the cost of insurance to the covered person from the employer or insurance companies. Consumer-directed health plans (CDHPs) allow employees to choose coverage options according to their needs. CDHPs allow more of the decision making control concerning health care costs, lifestyle choices, and treatment decisions to the individual, who can choose to participate in wellness programs or disease management training for a reduction in premiums. CDHPs include health reimbursement accounts or health saving accounts that have been slow to be offered by employee groups, but they are the trend of the future (Tynan & Christianson, 2008). Many employers consider a long education retraining necessary in order for employees to be knowledgeable with the multiple new choices of coverage available and have chosen to go slowly with the conversion to a CDHP program.
Medicare has attempted to decrease overall costs and improve service to the elderly by passing the Medicare Modernization Act in 2003 to expand medication coverage with Medicare Plan D. The medications are included in a deduction program with cost limitations and costs shared by the policy holder (Centers for Medicare and Medicaid Services, 2005). Medicare has also implemented the means testing provision so those persons that have a higher income pay more for their Medicare coverage starting in 2007 (Pauly, 2004). Medicare and Medicaid agencies understand that unless costs are controlled, the United States will no longer be able to finance the fast growing programs as they are administered today.
Health status in the future will greatly depend on the wellness programs in place in the present. The population is living longer, more chronic conditions are being better managed, and new technology has developed vaccines to control diseases. Wellness programs focus on screening for health issues, providing education on self-help resources, and prevention methods to remain healthy. Education can include weight reduction, smoking cessation, or the dangers of illegal drug use. The focus of future health will be to remain healthy instead of struggling to regain health.
The Department of Health and Human Services (HHS) recognizes the importance of getting the population more involved in their own health care and remaining healthy for the future. In 2000, HHS initiated Healthy People 2010 that established 467 objectives designed to improve the health of the nation for the future. The program includes 28 focus areas representing different health areas (Centers for Disease Control and Prevention, 2007). The focus of Healthy People 2010 is to eliminate health disparities and identify areas that need improvement. The National Center for Health Statistics is responsible for monitoring the data and making recommendations for future programs and changes.
Medicare has established the Chronic Care Improvement Plan (CCIP), which recognizes care of the chronically ill is expensive and medical costs can be decreased by effectively caring for this group (Shi & Singh, 2003, p. 576). Health Care Maintenance Organizations (HMO) utilize disease management programs that closely monitor the health of the chronically ill to keep them as healthy as possible. Telephonic nursing and distance monitoring are all methods to lower the cost of care and improve the health of patients (Martin & Coyle, 2006). Trends for the future will continue targeting elderly, chronically ill, high-risk patients to better manage their care by using allied health and nursing professionals.
Multiple studies have been done on the need to increase the percentage of minority representation in the health care profession. The Center for Health Care Professions, through a California Endowment Fund Project, suggested that minorities be recruited to work in their own communities, not only so the population would trust and understand them, but to provide them a profession that is well paid and necessary for that community. The minority population in California is projected to grow by 1.6 million between 2005 and 2030 (Bates & Chapman, 2008), so the need for more minority health care professionals is imperative to deliver needed care in the future.
Disparities in health care often come from the overwhelming needs of a nation. The health care delivery system sometimes cannot be everything needed by everyone. The aging population will continue to put an enormous burden on the health care system as the need for more chronic care issues arise. Minority populations are increasing and have been subjected to unfair quality of care issues, access to care issues, and lack of culturally competent care provider issues. The future outlook for health care is positive in that many of the disparities have been recognized and policies written to correct the injustices. Allied health professionals are in an excellent position to help correct these problems for the future.
Agency for Healthcare Research and Quality. (2004, February). National healthcare disparities report: Summary. Retrieved November 25, 2008, from http://www.ahrq.gov/qual/nhdr03/nhdrsum03.htm
American Medical Association. (2008, February). Minority affairs consortium: Report on racial and ethnic disparities in health care. Retrieved November 25, 2008, from http://www.ama-assn.org/ama/pub/category/6925.html
Bates, T., & Chapman, S. (2008, June). Allied health workforce analysis: San Diego region. Retrieved November 25, 2008, from the University of San Francisco Center for Health Professions Web site: http://www.calendow.org/uploadedFiles/AlliedHealthSanDiego.pdf
Centers for Disease Control and Prevention. (2007, October 19). Healthy people: Tracking the nation’s health, data 2010. Retrieved November 1, 2008, from http://www.cdc.gov/nchs/about/otheract/hpdata2010/abouthp.htm
Centers for Disease Control and Prevention. (2008, October). National center for health statistics. Retrieved November 26, 2008, from http://www.cdc.gov/nchs/
Centers for Medicare and Medicaid Services. (2005, December 14) Coordination of benefits part D. Retrieved November 25, 2008, from http://www.cms.hhs.gov/COBPartD/
Centers for Medicare and Medicaid Services. (2006, May 1). 2006 Medicare trustees report. Retrieved November 27, 2008, from http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1846
Institute of Medicine. (2002, March). Unequal treatment: What healthcare providers need to know about racial and ethic disparities in healthcare. Retrieved November 27, 2008, from http://www.iom.edu/Object.File/Master/4/175/Disparitieshcproviders8pgFINAL.pdf
Lecca, P. J., Valentine, P. A., & Lyons, K. J. (Ed.). (2003). Allied health: Practice issues and trends in the new millennium. New York: The Haworth Press.
Martin, E., & Coyle, M. (2006, March/April). Nursing protocol for telephonic supervision of clients. Rehabilitation Nursing, 31(2), 54-62. Retrieved November 25, 2008, from http://www.rehabnurse.org/pdf/RNC_252.pdf
Mead, H., Cartwright-Smith, L., Jones, K., Ramos, C., Woods, K., & Siegel, B. (2008, March). Racial and ethnic disparities in U.S. health care: A chartbook. Retrieved November 25, 2008, from http://www.commonwealthfund.org/usr_doc/Mead_racialethnicdisparities_chartbook_1111.pdf
Open Clinical. (2003, September). Clinical pathways: Multidisciplinary plans of best clinical practice. Retrieved November 26, 2008, from http://www.openclinical.org/clinicalpathways.html
Pauly, M. (2004, December 8). Means-Testing in Medicare: Health affairs: The policy journal of health sphere. Retrieved November 26, 2008, from http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.546
Shi, L., & Singh, D. A. (Eds.). (2008). Delivering health care in America: A systems approach. (4th ed.). Sudbury, MA: Jones and Bartlett.
Thompson, A. (2007, August 20). Strategies to eliminate disparities. Retrieved November 24, 2008, from http://www.progressivestates.org/content/656/eliminating-health-disparities
Tynan, A., & Christianson, J. (2008, March). Consumer-directed health plans: Mixed employer signals, complex market dynamics: Issue brief No. 119. Retrieved November 28, 2008, from http://hschange.org/CONTENT/976/?words
U.S. Census Bureau. (2007, May 17). Minority population tops 100 million. Retrieved November 27, 2008, from http://www.census.gov/Press-Release/www/releases/archives/population/010048.html
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1. Allied Health Workforce Analysis: San Diego Region
Review “Allied Health Workforce Analysis: San Diego Region.” by Bates and Chapman, located on The California Endowment website.
2. Clinical Pathways: Multidisciplinary Plans of Best Clinical Practice
Read “Clinical Pathways: Multidisciplinary Plans of Best Clinical Practice,” located on the Open Clinical website.
3. Eliminating Health Disparities
Read “Eliminating Health Disparities,” by Bacino, located on the Progressive States Network website (2007).
4. Health Care Trends 2008
Read “Health Care Trends 2008,” located on the American Medical Association website.
5. Healthy People 2020
Read “Healthy People 2020,” located on the Centers for Disease Control and Prevention website.
6. Nation’s Minorities Numbers Top 100M; Hispanics Account for Nearly Half of Growth
Read “Nation’s Minorities Numbers Top 100M; Hispanics Account for Nearly Half of Growth,” from USA Today (2007).
7. National Center for Health Statistics
Read ” National Center for Health Statistics,” located on the Centers for Disease Control and Prevention website.
8. National Healthcare Disparities Report: Summary
Read “National Healthcare Disparities Report: Summary,” located on the Agency for Healthcare Research and Quality Archive website.
9. Racial and Ethnic Disparities in U.S. Health Care: A Chartbook
Read “Racial and Ethnic Disparities in U.S. Health Care: A Chartbook,” Mead, Cartwright-Smith, Jones, Ramos, Woods, and Siegel (2008, March).
10. Report on Racial and Ethnic Disparities in Health Care
Read “Report on Racial and Ethnic Disparities in Health Care,” located on the American Medical Association website.
11. Unequal Treatment: What Healthcare Providers Need to Know About Racial and Ethnic Disparities in Healthcare
Read “What Healthcare Providers Need to Know About Racial and Ethnic Disparities in Healthcare,” located on the Institute of Medicine website.
1. Center for Health Equity Research and Promotion Collaborations
Explore the Center for Health Equity Research and Promotion Collaborations website.