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In an effort to address healthcare inequities, a group of national experts, including University of Hawaiʻi at Mānoa Thompson School of Social Work & Public Health Dean Alex Ortega, contributed to a federally sponsored publication. Ortega guest edited a special issue of Health Services Research released on November 28. The national collaboration of public and private sector partners was spearheaded by the Agency for Healthcare Research & Quality (AHRQ), an agency in the U.S. Department of Health and Human Services responsible for producing research and evidence to make health care safer, higher quality, more accessible, equitable and affordable.

Alex Ortega headshot
Alex Ortega

“It was an honor to be the guest editor of the special issue and a senior author of one of the papers, which highlights current thinking and understanding of healthcare inequities in the United States by leading academic and practice experts in the field,” said Ortega, who spent the past 25 years studying the complexities of inequities in access to, quality of, and experiences in healthcare for some of the nation’s most vulnerable populations, including Latinos, Asian Americans, immigrants, and those who receive Medicaid or are uninsured.

The Biden-Harris administration has made it a priority to further advance racial equity and support for underserved communities and mandated federal agencies to launch a comprehensive approach plan (Executive Order 13985). Taking steps toward identifying research priorities, this issue includes five key research and action areas that incorporate evidence and recommendations that provide a framework for AHRQ and the broader health service research community to advance health and healthcare equality across the nation.

Key themes covered include improving access to healthcare, reducing financial barriers to care, bolstering safety net systems, centering patient communities, acknowledging the impact of structural racism and developing strategies to reverse it, and the role of the healthcare workforce in influencing inequities.

The issue includes five commissioned papers that address actions that can be taken to advance equitable care: 1) Healthcare Delivery Systems and Structure, 2) Payment, 3) Social Determinants of Health and Social Needs, 4) Implementation Science and 5) Access to Care.

Improving health care systems

In addition to being guest editor of the issue, Ortega is the senior author on a paper that addressed improving health equity through healthcare systems research. The study identified priority themes and provided guidance and direction on federal research and funding for areas such as leadership, culture and the workforce, health equity-informed approaches to health system consolidation and access, whole person care, and community engagement and investment.

“It has long been known that the U.S. healthcare system is one of the most technological and scientifically advanced systems in the world, but we also know that the healthcare system is not equitable for everyone and sometimes it can cause harm to those who it serves. These harms are disproportionately felt by minoritized populations,” said Ortega. “The study identifies important areas of inquiry and practice to improve health systems so that they are of high quality, accessible and equitable for everyone, regardless of race and ethnicity, age, gender, citizenship and immigration status, occupational status, income, geographic location and other important demographic factors.”

He added, “The hope is that by focusing on best practices to achieve equity the healthcare system will be part of the solution to ending deeply-seated health disparities.”

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