Organizational strategies to tackle health-care disparities in the USA

US health policy is beginning to address health-care disparities, mainly in terms of racial/ethnic groups and access to care for vulnerable groups. Though not widespread, policies are engaging a wide range of organizations, including federal, state and local government, insurers, providers and philanthropic foundations. It initially seems strange that US health-care organizations (HCOs) are seeking to tackle disparities, as the system itself generates huge disparities. This article reviews the reasons underlying growing interest in disparities in the USA, examines the barriers and opportunities facing such initiatives and considers their likely impact. Demographic changes, efforts to widen access to care and to remedy health-care discrimination are the primary factors in driving these initiatives. HCOs (and others) are faced with implementation barriers including structural impediments of the health-care system, the limited extent to which the issue has permeated within HCOs, and data collection. Opportunities for progress can be garnered from the mounting evidence base, the various programmes being implemented, and emerging links with quality improvement initiatives. The USA is faced with ongoing efforts to keep the issue on the (policy and managerial) agenda, to integrate strategies into organizational systems and processes, and to monitor the effects of such strategies.