As part of my blog about the four-dimensional approach to eliminating health disparities, I’ve previously highlighted the importance of access to care. This week, I’ll discuss the role of systems quality.

Although access to healthcare is an essential piece of addressing disparities, efforts to end racial and other disparities will fail unless they address the other three dimensions, which include systems quality, provider attitudes/cultural competence and social determinants of health inequalites.

The question “Access to what?” needs to be asked. For example, let’s say we wake up and suddenly find ourselves in a world where everyone has full access to free health care. Would this solve health disparities and create a system where all had equal health? Clearly it would not, as we have already seen demonstrated in many systems in which all citizens have access to care but health outcomes continue to diverge vastly.


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It’s important to keep in mind that all access is not created equally. If some populations have access to inferior health care systems, little will be done to enhance health equity. Systems quality measures even the playing field and can help torpedo potential benefits to healthcare access.

Systems quality measures are increasingly common and include measures of infrastructure, facilities, provider training, equipment and relative ease of system navigation. Subpar performance in any of these areas can undermine access to care, leaving those suffering from the negative impact of health disparities with ongoing vulnerability and health burden.

Next week we’ll examine the increasingly scrutinized roles of provider attitudes, bias and culturally appropriate care in the 4D health disparities model.

Jim Anderson, MPAS, PA-C, ATC, is chair of the American Academy of Physician Assistants Health Disparities Work Group, founder of Physician Assistants for Health Equity and faculty of the Department of Anesthesia and Pain Medicine at the University of Washington School of Medicine in Seattle.