What is Going to Close the Health Equity Gap in the United States?

There are clear healthcare disparities in the United States. You know it, I know it, and the millions of Americans who struggle to access healthcare on account of their race, socioeconomic status, age, location, gender, disability status, and sexual orientation all know it too.

Apart from the obvious human cost, this gap has a massive impact on the U.S. economy. According to a recent analysis by Altarum, racial disparities alone account for approximately $93 billion in excess medical costs and $42 billion in lost productivity.

With numbers like these, you’d expect a whole range of actors — from government spendthrifts to productivity-conscious employers — to share a vested interest in eliminating the gap. But, while the will certainly exists, we’ve yet to find a way.

From Broad-Spectrum Policy to Precision-Targeted Health Technology

Systemic overhauls like ‘Obamacare” (the Affordable Care Act) have done much to narrow the gap. Even so, some folks like Shervin Assari — Research Investigator of Psychiatry and Public Health at the University of Michigan — have shown that many broad-scale changes such as ACA and community healthcare initiatives tend to favor the majority over the minority.

Where policy solutions come up short, many have turned to healthcare technology as the most fruitful avenue to the eradication of healthcare disparity in our country. The question of healthcare technology’s usefulness in closing the gap, however, is where and how that technology gets deployed: at the level of the patient or the provider?

As a team of researchers out of Norway have shown, to understand technology’s potential impact on the inequality gap, we can’t focus just on health care services technologies, but must also “investigate emerging technologies in lifestyle health, genomics, and the increased use of personalized devices in health.”

In other words, we need to get away from the provider and closer to the end-user to understand whether and how technology can put an end to the disparity.

This resonates well with Assari’s finding, for the extension of health technology to all would perpetuate the already existing inequality. The concentration of innovative technology in the hands of the most needy, however, would help to rectify existing inequities in the system.

The question is: what does that look like in practice?

Focusing on the End-User

CareMore Health represents just one innovator in this space. Partnering with Lyft to provide transportation for high-need Medicare and Medicaid patients, CareMore learned that innovation has less to do with a high-tech app that none of its patients would use and more to do with finding new-yet-simple ways to solve users’ low-tech transportation headaches. As a result, CareMore shortened wait times, improved satisfaction, and lowered overall transportation costs by more than $1 million per year.

CareMore provides a ready example of innovation focused on the marginalized end-user, but without ample economic incentives, what’s to say what they’ve done will catch on? The traditional “fee for service” model employed by hospitals enjoys the benefit of incumbency, and there’s little incentive for hospitals to challenge the status quo.

Thankfully, a decade’s worth of innovation is changing that dynamic. In the past 10 years, Medicaid and Medicare — not exactly known for their revolutionary thinking — have doled out handsome rewards to companies who’ve found a way to serve the underserved.

From startup insurance providers like Bright, Clover, and Devoted to innovators like Alphabet’s Verily, forward-thinking players in the healthcare space are shifting their attention to America’s poorest — all thanks to this government incentive structure.

As venture capital dollars follow, this state-sponsored dynamic funds the paradoxical concept that the future of healthcare technology may not rest in the halls of that billion dollar healthcare facility at the center of town. Rather, the future may lie in the hands of those poor, marginalized residents at the fringes of society.

It is fundamentally brilliant. So this means that those Americans that have poor access/healthcare today will likely get access to innovation before others because of how incentives are being provided to deliver better health outcomes in this population.

The healthcare gap in this country is deep and wide. While arguments can be raised for or against government intervention, it seems that a synergy is developing between the state and the market. So long as the incentive structures remain, we may soon see the health care gap closed by placing technology into the hands of those who need it most.