Chairman and Committee Members, I am Dr. Elena Rios, President & CEO, the National Hispanic Medical Association, a non profit association in Washington, DC representing Hispanic physicians. The NHMA mission is to improve the health of Hispanics and other underserved.

The NHMA supports policies that will reform public health and medical services to decrease health care disparities and improve health status of Hispanics and other vulnerable groups.
The Unequal Treatment Report highlights the recommendations needed to decrease health care disparities – educate the leadership about health care disparities, diversify the health care workforce, expand cultural competence training, expand data collection with racial/ethnic and language variables and support research on the system’s responsiveness to minority populations – access, utilization patterns, performance measures, innovation, and “collecting data on race, ethnicity, and language of preference is a quality of care as well as a civil rights issue.” [1]
Evidenced-based public health and medicine strategies are necessary to decrease variation of service delivery that impacts and rations care to Latinos, especially in our poor neighborhoods. We know from the annual AHRQ National Health Care Disparities Reports[2] that our community has the worst access and quality care compared to non-Hispanics in the nation.
The U.S. is facing a tremendous growth of the diversity in the population. According to the Census Bureau, by 2042, one out of four Americans will be of Hispanic origin. We support the Obama Administration deliberations to help shift health care delivery based on increased services for acute and chronic disease to a systemic approach with integrated care in a region that is responsive to its population and focuses on prevention first. Medical treatment should be based on comparative effectiveness value of treatment strategies that produce the greatest benefit for the Hispanic community at the lowest cost.
We recognize that comparative effectiveness research is about value in health care. According to the report, HHS in the 21st Century, “assessments of value should include measures of both individual and societal costs and benefits that result from research on prevention and treatment as well as methods of organizing, delivering and paying for services.”[3]
Yet, despite this research being supported by the federal government over the past several years, we recognize there have been alarms sounded  - the Congressional Black Caucus says beware of producing information for ‘ a one size fits all’ approach that could decrease access to treatments for minority patients;[4] and Amgen and Johnson and Johnson in the HHS in the 21st Century report cautioned that cost comparisons could lead to increased costs and rationing care.
However, we believe that comparative effectiveness research will add to the body of knowledge for reducing health disparities for 1) physicians to use to improve quality care for patients; as well as 2) for administrators to use to improve health systems of delivery in the following priority areas:
  1. Cultural competence and health literacy research in order to ultimately change behaviors and improve lifestyle in our communities
  2. Effective ways of communicating with Hispanic patients and their families
  3. Knowledge about health disparities interventions between hospital systems and clinics that have longstanding experience with Hispanic physicians and their patients
  4. Innovative research targeted to Hispanic patients and their families
  5. Integrated care that is outcomes based – and with mental health and oral health as well as physical health
Besides supporting comparative effectiveness research studies, there is a need to develop the mechanisms to share the research results with our minority provider community. HHS could lead the development of public private partnerships with Hispanic health care professionals and community based leaders about rewarding caregivers or showcasing providers who deliver high value care to Hispanics and to increase Hispanic physicians and others to participate in focus groups to develop mechanisms for information dissemination to providers in our communities.
HHS should take this opportunity to develop Hispanic health professional researchers by targeting the untapped pool of Hispanic health professional students and residents and graduate students interested in serving in their communities.
Lastly, given the growth of the Hispanic population, there is a need to create regional areas for Hispanic health research and follow the health care decision-making in the health systems.

[1] Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC, 2003
[2] Agency for Healthcare Research and Quality. National Disparities Report. Washington, DC, 2008
[3] Institute of Medicine. HHS in the 21st Century: Charting a New Course for a Healthier America. Washington, DC. 2009
[4] Cohen, Paula Hartman, “Comparative Effectiveness Research: Boon or Burden for Minorities”, 2009.

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