Over the past decade, a rapidly expanding body of scientific evidence has documented differences in health status among US racial and ethnic groups. These disparities in health status are generally thought to be related to factors beyond the scope of the healthcare system (Smedley, Stith, & Nelson, 2003). In contrast, disparities in health care are thought to be limited to determinants more closely related to the healthcare system. Obviously, the logic of such reasoning is clear. However, mounting evidence suggests that as a practical matter, this distinction may be of little value. This is in part because growing proportions of the population are living with chronic diseases. Approximately 60% of UK citizens and 50% of US citizens report having at least one chronic disease. These numbers are expected to rise further in the near future. Additionally, both US and European healthcare systems are oriented toward acute episodic inpatient treatment, and, as such, have only limited ability in their current configurations to respond adequately to this growing problem. Indeed, the World Health Organization (WHO) has suggested that healthcare systems worldwide are struggling to meet the needs of population's suffering from chronic diseases (National Health Service, 2004). Obviously then, fragmented healthcare delivery systems and increasing numbers of individuals with multiple comorbid conditions contribute directly to poor quality care, unnecessary medical errors, and poor patient outcomes (IOM Committee on Quality of Healthcare in America, 2001; National Health Service), thus also contributing to healthcare disparities.
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