DISPARITIES: Why and What to do About Them?

1. DISPARITIES:Why and What to do About Them? Presented to The Institute for Healthcare Disparities 1st Annual National Best Practices ConferenceApril 17, 2009 1st Annual Conference John W. Bluford President/CEO Truman Medical Centers

2. USA Public Policy Overview • 1860s Bureau of Refugees, Freedmen, and Abandoned Lands • 1940s Hill-Burton Act The Hospital Survey & Construction Act, 1946 • 1960s Medicare & Medicaid • 1960-70s OEO Neighborhood Health Centers • 1973 Health Maintenance Organization Act

3. During Slavery

4. USA Public Policy Bureau of Refugees, Freedmen, and Abandoned Lands (“Freedmen’s Bureau”) – 1860s

5. Black Hospitals in the U.S.

6. USA Public Policy Hill-Burton Act - 1946 (The Hospital Survey & Construction Act) • Intent • Build & Modernize Hospitals • Separate-but-Equal Funding • Provide Uncompensated Care • Actual • $4+ Billion Spent from 1946-1978 • Unequal Allocation of Resources Lister Hill U.S. Congressman, Alabama Harold H. Burton U.S. Senator, Ohio Mayor

7. Good Samaritan-Waverly Hospital Richland County, South Carolina

8. Cook County – Chicago Charity – New Orleans Grady Memorial – Atlanta Jackson Memorial – Miami Harlem – New York As Opposed to:Major Teaching Hospitals Providing Care for Minorities

9. USA Public Policy • Medicare / Medicaid – 1960s • Health Maintenance Organization Act – 1973 (HMO Act of 1973)

10. What to do about Disparities as an Industry • Invest in Quality Improvement • “Patient Centered” • Diversify Governance • Enhance Community Benefit Reporting • Focus on Public Health Issues • Enhance Wellness & Prevention Outreach • Enhance Diverse Workforce Opportunities

11. WHY? Because We Care. We are in the business of caring. To be effective, we must cross Social – Economic – Cultural barriers.