Health care policy to eliminate racial and ethnic disparities in the United States: What Canada can offer and why it is not enough

While United States health care reform efforts promise to increase access to health insurance nationwide, even universal access to insurance would likely be insufficient to eliminate racial and ethnic health inequities. To explore the impact of health insurance on racial disparities and inform policy initiatives focused on eliminating these inequalities, a literature review was performed comparing racial and ethnic health outcomes, overall health status, and health insurance systems in the United States and Canada. Findings indicate that racial and ethnic health disparities persist in both countries and that the greater disparity observed in the United States is likely a direct result of the lack of universal access to health insurance. Accordingly, increasing access to insurance coverage may be the single most effective method to decrease racial and ethnic disparities in U.S. health care, where approximately 55% of the estimated 45.7 million uninsured are people of color. Nevertheless, studies consistently reveal that health insurance alone cannot eliminate or even explain a majority of disparate health outcomes. It follows that the elimination of disparities requires federal legislative efforts that focus not only on expanding access to insurance but on holding health care organizations, insurance companies, and providers accountable for reducing and eliminating racial inequities. Policy implications including the potential impact of pending health care reform legislation on racial and ethnic disparities and the need for reform efforts focused explicitly on the elimination of racial inequities will be addressed. Specific recommendations to inform such policy efforts will also be discussed.