By Dana Gentry
Nevada’s health care system ranks 41st overall of the 50 states and District of Columbia, according to a report detailing disparities in health care and wellness across racial and ethnic groups.
The care afforded to white residents ranks at 39th in the nation, says the report from the Commonwealth Fund, an independent, non-partisan organization dedicated to improving health care. Nevada ranks 35th for health services available to Black residents, and 36th for services available to Hispanics.
The care provided to Asian American and Native Hawaiians or Pacific Islander (AANHPI) residents of Nevada ranked 25th in the nation – the state’s highest ranking in the study.
Premature death from avoidable causes
The report notes that health outcomes, measured by death rates and the presence of health problems, also vary by race and ethnicity.
“Deep-seated racial and ethnic health disparities persist across the United States, even in states with otherwise high-performing health systems,” says the report.
Black Americans, American Indians and Alaskans have lower life expectancies than others, and experienced more COVID-related deaths, the report says.
In Nevada, Blacks had the highest rate of premature deaths (age 75 and under) from avoidable causes with 553 per 100,000 residents, according to the Centers for Disease Control National Vital Statistics System for 2020 and 2021, followed by AIAN at 549 per 100,000. AANHPI residents in Nevada had the lowest death rate at 237 per 100,000, followed by Hispanics at 286, and white Nevadans at 374 per 100,000.
Health Care Access
Racial and ethnic disparities in health care are perpetuated by less insurance coverage and unequal access to high-quality care, the report says.
“Large disparities in health care access between white people and members of most other racial and ethnic groups are apparent across states,” the report says. “Hispanic people have the highest uninsured rates and cost-related problems in getting care.”
While more Americans have become insured since the Affordable Care Act became law, some 25 million people remain uninsured.
“In nearly all states, uninsured rates continue to be higher for Black, Hispanic, and AIAN residents than they are for white and AANHPI residents,” the report says.
In Nevada, Hispanics have the highest percentage of uninsured adults at 26,4%, followed by Blacks at 16.2%, AANPHI at 11.2%, and whites at 9%.
“Some Hispanic and AANHPI populations continue to face immigration-related barriers to getting subsidized coverage through Medicaid or the ACA marketplaces,” the report says.
Americans who don’t have insurance or have plans that lack comprehensive coverage are “unable to get care when they need it or have to pay high out-of-pocket costs for their care,” the report says. “With comparatively lower incomes and fewer savings, Black, Hispanic, and AIAN people are more likely to report experiencing delays in their care or financial distress.”
Access and use of primary care
“Across and within most states, white people overall receive better quality of care than Black, Hispanic, AIAN, and, often, AANHPI people,” the report says, noting primary care clinicians play a critical role in ensuring quality services.
Patients tend to have better outcomes when they receive care from providers of the same racial background, the report says.
“When there are barriers to obtaining primary care, such as costs or a lack of providers, people are more likely to get care in more intense and costly care settings, particularly an emergency department,” the report says, noting Black patients covered by Medicare are more likely than white patients to be hospitalized for “acute exacerbations of chronic conditions” that could be treated and managed by primary care providers. “For all Medicare beneficiaries, greater use of primary care services is associated with less use of Emergency Departments for treatable conditions and fewer hospital admissions.”
In Nevada, Black residents have 31.9 admissions per 1,000 Medicare patients to hospitals for conditions that could be treated outside a healthcare facility, compared with white residents who are hospitalized for such conditions at a rate of 23.5 per 1,000 Medicare patients.
Black patients are admitted to emergency departments for avoidable conditions in Nevada at a rate of 181 per 1,000 Medicare patients, compared with 132 for white patients.
The report asserts that equity in health care should be a top priority for policymakers, and urges leaders to evaluate existing policies that thwart the effort.
Among the report’s suggestions:
- Congress could extend the insurance premium subsidies set to expire in 2025
- States that have not expanded Medicaid could do so
- Congress could reduce deductibles and out-of-pocket costs for marketplace plans.
- Congress could reduce immigration-related barriers to insurance coverage
- Lawmakers could allow undocumented, low-income immigrants to enroll in Medicaid, as several states have already done
- Policymakers could strengthen primary care by reimbursing providers based on the value of care they deliver
