Intended for healthcare professionals


Measuring disparities in health care

BMJ 2006; 333 doi: (Published 03 August 2006) Cite this as: BMJ 2006;333:274
  1. Jennifer Prah Ruger (, assistant professor
  1. Yale University School of Medicine, Department of Epidemiology and Public Health, PO Box 208034, New Haven, CT 06520, USA

    The gap between high and low quality care within groups matters more than gaps between groups

    Disparities in the quality of health care and in the occurrence of medical errors are hot issues in contemporary medicine and health policy. This debate stems mainly from reports on disparities in the quality of health care by the US Institute of Medicine and recommendations for health systems to reduce “medical errors.”1 2 Given evidence of stratification in healthcare quality by racial, ethnic, geographic, gender, and socioeconomic factors, we still have not settled on the right methods for quantifying inequalities. Policy responses will depend on appropriate methods.

    Asch and colleagues3 recently studied the variation in rates at which people in different sociodemographic subgroups in the United States received necessary health care. In each subgroup they found a large gap between the observed and desired …

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