Domains of Quality: Equity

The Institute of Medicine (IOM) considers equity to be one of the six domains of healthcare quality. Equity can be understood as reducing disparities in healthcare regardless of race, ethnicity, English proficiency, type of insurance, or socioeconomic status. Disparities or inequities in care are of particular concern in California because of the rich diversity of cultures and languages spoken in our state.

When we encounter disparities, we are identifying an opportunity to improve-either someone is getting too much of a service, or someone else is not getting enough. Identifying disparities allows us to pinpoint gaps in quality and target healthcare services to the specific populations in need. When we identify gaps in quality, we should have a complete understanding of the population being served if we hope to offer culturally appropriate services.

Although there is little information available on equity through well established healthcare quality measures such as HEDIS or CAHPS, AHRQ provides important information on equity in its National Healthcare Disparities Report.

Language Services

One measure of equity is whether the services provided to those with limited English proficiency is comparable to those who are English proficient. Researchers have found disparities in the healthcare received between those who are English proficient and those who are not. In fact, studies suggest that limited English proficiency may be the biggest barrier to high quality healthcare.

Both Medi-Cal, and the Department of Managed Health Care that oversees HMOs in California, have established standards that spell out the scope of language services enrollees should receive. However, there is little information available on language services through well established health care quality measures such as HEDIS or CAHPS.

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