Achieving Equality : Healthcare Governance in Transition

Racial and ethnic disparities in health care outcomes are well-documented. Efforts to reduce these inequities have not succeeded in achieving a substantial reduction. The disease management model, which emerged during the era of managed care, is gaining support as an alternative approach to reducing disparities. Reformist institutions including community health centers and physician-led managed care organizations are already adopting a patient-centered delivery system that embodies the disease management approach. These reformist institutions illustrate the potential for redesigned health care governance that can embed a quality/equity norm. This redesigned governance includes revising the relationship between levels of government, using horizontal networks for learning and policymaking, and linking public and private institutions and regulations. This article suggests that the timing is propitious for a development of alliances among stakeholders to implement this new design. Throughout the development of this new system, advocates must participate to ensure a decrease in inequities