How ‘Obamacare’ impacts eye health disparities

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Vision health disparities are a serious issue in the United States among minorities, and many are hoping provisions in the Affordable Care Act will be able to alleviate the issue.

By Rose Schneider, Content Specialist, Ophthalmology Times

Detroit-Disparities in vision and eye health-care opportunities among minorities is a big problem in the United States, according to M. Roy Wilson, MD, MS.

Furthermore, Dr. Wilson explained that these disparities have resulted in a high number of unnecessary vision loss among American minorities, as 6.9% of African Americans and 9.2% of Hispanics have impaired vision that could be easily remedied with eyeglasses.

‘There are a number of ophthalmic diseases for which there are disparities based on either race, ethnicity, or socially economic status,” said Dr. Wilson, president of Wayne State University, Detroit.

Though many physicians see the disparities problem as exclusively an access issue, Dr. Wilson said he believes there are more factors that play a role as well.

“There is lots of evidence that it’s not just access,” said Dr. Wilson, who is also the former deputy director for strategic scientific planning and program coordination at the National Institute on Minority and Health Disparities (NIMHD) of the National Institutes of Health (NIH). “The problem is much more widespread.”

That is where the Affordable Care Act (ACA) will come into play, Dr. Wilson said, as the health-care overhaul has the potential to reduce the dilemma greatly, while addressing its various causes.

ACA impact

There are four areas, Dr. Wilson explained, in which the ACA may have a significant impact on decreasing vision related disparities among minorities:

1. Infrastructure: The ACA has elevated the National Center for Minority Health and Health Disparities into the NIMHD. The act has given the newly formed agency overall responsibility for strategic planning and program coordination for all the health disparities related to research and training for the entire NIH.

The act also established the Office of Minority Health in the Health and Human Services Department, as well as in other government offices like the Centers for Disease Control and the Centers for Medicare and Medicaid.

2. Access: The health-care overhaul included many increased access provisions, including Medicaid expansion, insurance regulation/the American health benefit exchange, community health centers creation, as well as prevention and wellness additions.

These specific changes the ACA brings, Dr. Wilson said, could turn out to make a large impact on accessibility to health-care by minorities.

“Simply because more minorities (currently) have difficult with access,” he added.

3. Health-care workforce and cultural competency: There are a number of provisions associated with this area, as its intent is to improve the diversity of the workforce.

4. Quality improvement: The ACA will increase data collection and research to improve the quality of health-care for minorities.

Research and data collection

Dr. Wilson said he believes the quality of health-care, not just access to it, is one of the most critical aspects to focus on in regard to vision-related disparities.

“To me, one of the most important things the ACA did with respect to health disparities, is that all federal funded health programs and surveys are now required to collect and report on every patient’s race, ethnicity, and language preferences using Health and Human Services definitions with the goal of ultimately reducing disparities,” he said.

Another way the ACA is encouraging further data collection and research to combat disparities is through electronic health records (EHRs).

Dr. Wilson explained that many physicians have advocated for some type of national eye health surveillance mechanism to reduce disparities in vision and eye health.

“There’s a lot of potential for (EHRs here),” he said.

This method could still be an issue, because not all physicians have EHRs, Dr. Wilson said.

“(However), the ACA is moving most practitioners in that direction,” he said. “There is potential for going from individual data to population data, which will facilitate health surveillance on a population level, which can then be used to track and monitor progression and outcomes of disease better to address health disparities.”

But EHR cannot accomplish this alone, Dr. Wilson said. Some kind of system that brings all the necessary components together and to analyze them is needed.

One of the ways to do this is through clinical data registry, he said.

“This is an area that has much potential, because if you track data by . . . race and ethnicity and language preference, then you’re going to get better care all the way around,” Dr. Wilson said. “Hopefully, for most of those conditions that you’re tracking, you’re going to reduce the difference between different populations’ outcomes.”

Looking further

Another route the ACA will utilize research to combat health disparities is through the creation of the Patient-Centered Outcomes Research Institute (PCORI).

Dr. Wilson said PCORI assures that research will address the health-care needs of all patient populations, which is needed, as treatments may not work equally for everyone.

Though Dr. Wilson said he believes these ACA provisions and agency creations will most certainly alleviate eye health disparities, because of the act’s difficult rollout, the exact impact is still up in the air.

“One of the issues with the ACA is a lot of it hasn’t been implemented and there’s been a lot of hold up,” he said. “So even though a lot of the provisions have been passed, they haven’t been funded.

“Because of political considerations, some of this is still in doubt,” he added. “How many of those are actually implemented . . . will depend on a lot of political factors and will ultimately determine how effective the ACA is in addressing health disparities.”

M. Roy Wilson, MD, MS

P: 313/577-2230

E: president@wayne.edu

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