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Paper finds gap in DUHS insurance

When Dr. Victor Dzau, chancellor for health affairs and president and CEO of the Duke University Health System, took the helm of DUHS in 2004, one of his major goals was to place an increased emphasis on recruiting minority employees.

With a minority demographic make-up that closely mirrors the population of North Carolina, it appears the job has been done. But a new report presented Wednesday by Barak Richman, associate professor of law, indicates that once minorities are in the health system, some problems may just begin.

The paper, sponsored in part by the Provost's Common Fund, put forth concerns that white employees are much more likely to seek mental health care and pharmaceuticals, as well as more likely to receive greater benefits from their insurance companies than minority employees.

The report was based on data from the 22,000 employees of the University and DUHS, but Richman said the findings mirror a greater national trend.

"The American health care system is geared such that it essentially siphons from the lower-income and disenfranchised individuals to benefit high-income and privileged use," Richman said. "And if that's the case, we've got a big problem on our hands because that's not the way we should do things."

Because all Duke employees have access to the same health care plans and resources, Richman added that the report separated itself from previous research by truly analyzing the effects of race and income on health care disparities.

"[These results indicate] that whites not only seek care more regularly than African Americans and Asians, but that they also get a lot more out of their insurance in terms of pure dollars," Richman said.

"We see a real problem where the way we collect money for health insurance and then distribute benefits is a really regressive system," he added. "It's not helping the people who are already left out of the health system and it's not helping the people who health benefits are really supposed to help."

The report found a smaller correlation between income earned and care received, but it was still evident that higher-income employees were more likely to receive and seek mental health care and pharmaceutical benefits than lower-income employees, Richman said.

The paper comes at a vital time in national politics because the Mental Health Parity Act of 1996 is up for review, Richman said, calling the issue an "alarming and important policy question."

"These guys are arguing if you expand benefits, you are going to alleviate those disparities... but it seems to me that if you expand insurance and only the [majority is] taking greater advantage of that, then you might be hurting those you are really trying to help," Richman said.

Although the report primarily focused on the actual disparities in the health system, Richman proposed three possible reasons for why the differences were evident-provider discrimination, racial stigmas in perceptions of mental illness and a hesitation by minorities to seek care from white providers.

Although Richman said the data set was expansive, he admitted that there were still "holes" and areas that needed to be explored, such as the effects of household income and the possibility that minorities are seeking health care through other venues.

An audience composed primarily of Duke employees raised various concerns about the report, including thoughts that the data did not account for the effect of co-payments deterring minorities from seeking care. One audience member suggested that first-generation immigrants may be less likely to seek care than second-generation minorities.

Another attendee questioned whether a propensity for doctors to receive care more frequently than other individuals may have skewed the report's results.

Richman agreed that there is much work left to be done, but he said his ultimate goal in creating the report was to help the University make positive changes to its health care system. "I would be delighted to get some face-time with Dr. Dzau and bend his ear over what I've found. In Duke [Human Resources'] defense, one reason they are doing this is because they really want to know the results-they want to improve its benefits policies," Richman said. "Hopefully, Duke really can learn from these results."

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