Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care - Hardcover

Institute Of Medicine; Board On Health Sciences Policy; Committee On Understanding And Eliminating Racial And Ethnic Disparities In Health Care

Hardcover

ISBN 10: 030908265X ISBN 13: 9780309082655

Publisher: National Academies Press, 2009

Synopsis

Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received.

In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed.

How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.

Table of Contents

• Front Matter
• Summary
• 1 Introduction and Literature Review
• 2 The Healthcare Environment and Its Relation to Disparities
• 3 Assessing Potential Sources of Racial and Ethnic Disparities in Care: Patient- and System-Level Factors
• 4 Assessing Potential Sources of Racial and Ethnic Disparities in Care: The Clinical Encounter
• 5 Interventions: Systemic Strategies
• 6 Interventions: Cross-Cultural Education in the Health Professions
• 7 Data Collection and Monitoring
• 8 Needed Research
• References
• Appendixes
• A Data Sources and Methods
• B Literature Review
• C Federal-Level and Other Initiatives to Address Racial and Ethnic Disparities in Healthcare
• D Racial Disparities in Healthcare: Highlights from Focus Group Findings
• E Committee and Staff Biographies
• Paper Contributions
• Racial and Ethnic Disparities in Diagnosis and Treatment: A Review of the Evidence and a Consideration of Causes - H. Jack Geiger
• Racial and Ethnic Disparities in Healthcare: A Background and History - W. Michael Byrd and Linda A. Clayton
• The Rationing of Healthcare and Health Disparity for the American Indians/Alaska Natives - Jennie R. Joe
• Patient-Provider Communication: The Effect of Race and Ethnicity on Process and Outcomes of Healthcare - Lisa A. Cooper and Debra L. Roter
• The Culture of Medicine and Racial, Ethnic, and Class Disparities in Healthcare - Mary-Jo DelVecchio Good, Cara James, Byron J. Good, and Anne E. Becker
• The Civil Rights Dimension of Racial and Ethnic Disparities in Health Status - Thomas E. Perez
• Racial and Ethnic Disparities in Healthcare: Issues in the Design, Structure, and Administration of Federal Healthcare Financing Programs Supported Through Direct Public Funding - Sara Rosenbaum
• The Impact of Cost Containment Efforts on Racial and Ethnic Disparities in Healthcare: A Conceptualization - Thomas Rice
• Racial and Ethnic Disparities in Healthcare: An Ethical Analysis of When and How They Matter - Madison Powers and Ruth Faden
• Index

About this title

About the Author:

Brian D. Smedley, Adrienne Y. Stith, and Alan R. Nelson, Editors, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care

From The New England Journal of Medicine:

The life expectancy of members of most minority groups in the United States is shorter than it is for white Americans. For example, the gap in life expectancy between black Americans and white Americans is about six years. Against this bleak backdrop, a group of scholars assembled by the Institute of Medicine has taken on the issue of racial disparities in health care. In Unequal Treatment, they deal with several questions. In the United States, are there disparities in treatment between patients who are members of minority groups and those who are not, when both groups have similar access to care? If so, can we determine what underlies these disparities and what we should do about them? The medical literature reviewed in this book should convince even skeptics that members of minority groups receive treatment for their health problems that is different from the treatment received by others. However, determining whether these differences exist when all patients have equal access to care is a thornier issue. Two approaches are commonly used to analyze this problem: one is to examine the treatment of patients at a single location; the other is to investigate the treatment of patients who have the same insurance. Unfortunately, both of these experimental designs fall short of the ideal condition, in which all patients have equal access to the same range of services and expertise. As a result, no one can be certain whether disparities in treatment reflect unequal treatment of two groups of patients with equal access to health care or unequal treatment of two groups owing to a difference in resources, such as the availability of subspecialists and well-stocked pharmacies. After careful consideration of the evidence, the editors favor the former explanation: unequal treatment despite equal access. They ground this view in well-described and engaging theories about the roles of race, nonverbal communication, and inferential thinking that invisibly alter the clinical encounter between a patient who is a member of a minority group and a physician who is not. They conclude that "stereotyping, biases, and uncertainty on the part of the healthcare providers can all contribute to unequal treatment." This conclusion is important and remarkable, in that it redefines the problem of disparities in health care as a problem not of uneven access but of moral failure. In this context, the editors' recommendations make sense. Poor treatment of minorities should be considered an abrogation of civil rights. Doctors' understanding of their minority patients should be enhanced through educational programs on disparities in treatment and on cultural competency. The medical profession's myopia regarding minority issues should be addressed by enriching the physician workforce with more members of minority groups. I believe, however, that if we focus our attention on eliminating racial disparities, we will fall short of our aspirations. Decades of research have shown that the care received by patients who do not belong to a minority group is also frequently of poor quality, meaning that by aiming for parity we aim too low. An alternative is to focus purely on maximizing the quality of care received by underserved populations. Our success in this endeavor would be reflected within these communities, rather than measured by comparison with other populations. We could provide additional reimbursement to physicians who treat underserved patients, rather than threaten them with charges of civil-rights violations. In England, the National Health Service has experimented successfully with a deprivation payment system. According to this system, general practitioners who work in underprivileged areas of the country receive additional reimbursement for the care they provide, in part on the premise that the barriers to providing optimal care are greater in such areas. We could also target the specific conditions that most impair health and economic viability in minority communities. Currently, childhood asthma is rampant in inner cities and has severe economic consequences for affected families: every exacerbation requires both the child and the caregiver to stay at home, thus impeding the child's educational success and the adult caregiver's professional success. Harlem Hospital, in New York City, has engaged in intensive community outreach that has mitigated the burden imposed by this condition. If our aim is to follow Harlem Hospital's lead on a larger scale, it will be better served by educating doctors about the strong relation between poverty and environment than by educating them about the relatively weak relation between skin color and treatment preferences. These alternative approaches could have received more consideration in this engaging book. Peter B. Bach, M.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

About this edition

• Publisher: National Academies Press
• Publication date: 2009
• ISBN 10: 030908265X
• ISBN 13: 9780309082655
• Binding: Hardcover
• Number of pages: 780
• Editor: Nelson Alan R., Stith Adrienne Y., Smedley Brian D.