Three themes from the 2012 NHQR and NHDR emphasize the need to accelerate progress if the Nation is to achieve higher quality and more equitable health care in the near future: 

• Health care quality and access are suboptimal, especially for minority and low-income groups. 
• Overall quality is improving, access is getting worse, and disparities are not changing. 
• Urgent attention is warranted to ensure continued improvements in:
  • Quality of diabetes care, maternal and child health care, and adverse events. 
  • Disparities in cancer care. 
  • Quality of care among states in the South. 

Health Care Quality and Access Are Suboptimal, Especially for Minority and Low-Income Groups

Disparities in quality of care are common:

• Blacks received worse care than Whites, and Hispanics received worse care than nonHispanic Whites for about 40% of quality measures.
• American Indians and Alaska Natives (AI/ANs) received worse care than Whites for one-third of quality measures.
• Asians received worse care than Whites for about one-quarter of quality measures but better care than Whites for a similar proportion of quality measures.
• Poor and low-income people received worse care than high-income people for about 60% of quality measures; middle-income people received worse care for more than half the measures.

Disparities in access are also common, especially among AI/ANs, Hispanics, and poor people:

• Blacks had worse access to care than Whites for one-third of measures, and AI/ANs had worse access to care than Whites for about 40% of access measures.
• Asians had worse access to care than Whites for about 20% of access measures but better access to care than Whites for a similar proportion of access measures.
• Hispanics had worse access to care than non-Hispanic Whites for about 70% of measures.
• Poor people had worse access to care than high-income people for all measures; lowincome people had worse access to care for more than 80% of measures, and middleincome people had worse access to care for about 70% of measures.

Overall Quality Is Improving, Access Is Getting Worse, and Disparities Are Not Improving

Problems with quality of care are decreasing while problems with access to care are increasing: 

• In 2005, Americans failed to receive about 34% of health care services they should have received; by 2009, this had fallen to 30% of services. 
• In 2002, 24% of Americans encountered difficulties accessing health care; by 2009, this had increased to 26% of Americans. 

Quality is improving slowly for all groups: 

• Across all measures of health care quality tracked in the reports, almost 60% showed improvement. 
• Improvement occurred among all racial, ethnic, and income groups.

Access is getting worse for most groups: 

• Across the measures of health care access tracked in the reports, only one showed improvement and almost half were getting worse. 
• For most racial, ethnic, and income groups, the number of access measures that were getting worse exceeded the number that were improving.

Few disparities in quality of care are improving (getting smaller): 

• Few disparities in quality of care related to race, ethnicity, or income showed significant improvement, although the number of disparities that were getting smaller typically exceeded the number of disparities that were getting larger. 
• Disparities that were getting smaller include differences between Hispanics and nonHispanic Whites in rates of admission for congestive heart failure. Disparities that were getting larger include differences between Blacks and Whites in rates of advanced stage breast cancer.

Almost no disparities in access to care are improving (getting smaller): 

• The gap in access between Asians and Whites improved (grew smaller) for one measure (people without a usual source of care who indicate a financial or insurance reason for not having a source of care). No other disparities in access to care showed improvement. 

With black Americans leading the country with troubling statistics in areas like unemployment, child abuse and neglect, and domestic violence, all of which can exacerbate stress, it is perhaps not surprising that the community leads the country in mental-health struggles. According to the Centers for Disease Control and Prevention's Office of Minority Health and Health Disparities, African Americans are still "more likely to experience a mental disorder than their white counterparts" but "less likely to seek treatment," though Psychology Today recently noted that there has been an increase in the number of black Americans seeking treatment for ailments such as depression over the last decade. Men are less likely to seek treatment than women, regardless of race, meaning black men are among the least likely to seek treatment overall.

One of the main reasons African Americans are less likely to seek treatment for mental-health woes is the same reason black Americans are less likely to seek treatment for other health problems: economics. More than 20 percent of black Americans are uninsured. According to the American Psychiatric Association, "For those with insurance, coverage for mental-health services and substance-use disorders is substantially lower than coverage for other medical illnesses such as hypertension and diabetes." But besides cost, one of the greatest barriers keeping black Americans from seeking treatment for mental illness may be history.

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