PROJECTGuide to Equity in the US Health Care System

Urban Institute researchers created this guide to serve as a vital resource for advocates and other changemakers tackling the profound inequities in the US health care system. The guide establishes a common understanding of the complex health care landscape, with diverse stakeholders driven by incentives and regulations.

The primary goal of this guide is to equip advocates and changemakers by introducing key information about 10 sectors of the US health care system. It overviews the system’s inequities and highlights the policy, implementation, and accountability levers that can drive change. Ultimately, this collection of resources supplies advocates and changemakers with the knowledge needed to effectively advocate for policies that address racial and ethnic disparities in the US health care system.

Understanding Health Care Systems

The US health care system is fragmented and comprises many sectors and programs. To drive systemic change, changemakers must understand parts of the health care system that cater to patients based on their insurance status, primary health coverage, or health care needs. While there may be some overlap across health care sectors regarding providers, payers, oversight entities, and policies, each part of the system has unique challenges and opportunities. These differences necessitate tailored approaches for policy, practice, and program improvements, all directed toward achieving high-quality and equitable outcomes for patients.

Each guide includes the following:

  1. a concise sector description
  2. key characteristics of the population served
  3. provider information
  4. financing details
  5. barriers to access, quality, and equitable outcomes
  6. a summary of documented disparities
  7. a list of primary oversight entities and accountability mechanisms
  8. policies and actions to reduce barriers and disparities
  9. a patient story illustrating real-life experiences
  10. additional resources and a glossary of terms

The Urban Institute team collected this information through public sources, literature, a community advisory board, and expert feedback. While these insights offer a high-level understanding of different health care systems, federal, state, and local program policies and insurance market variations may affect applicability.


Recommendations for Advancing Equitable Health Care across Systems

Although each part of the US health care system has distinct players, rules, and leverage points, an overarching theme persists: barriers and disparities permeate all aspects of our health care system. Families at the lower end of the socioeconomic ladder, racial and ethnic minority groups, and those with complex health care often bear the brunt of these challenges.

While the ideal goal is universal, high-quality, culturally and linguistically effective health care, several broad changes can enhance access to care and health outcomes. The recommendations for federal and state policies include, but are not limited to, the following:

Policy Centers Health Policy Center
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