Why do Health Disparities Exist?
There are many factors that may contribute to racial and ethnic disparities in health care. Among the better-controlled studies performed to assess these factors, the vast majority indicated that minorities are less likely than whites to receive needed services, including clinically necessary procedures. Let's look at some of the reasons for this:
- Healthcare delivery systems and access to health care: In examining healthcare access issues, one must also consider the legal and regulatory climate in which healthcare systems operate, including factors such as cultural or linguistic barriers (e.g. the lack of interpretation services for patients with limited English speaking skills), fragmentation of healthcare systems (which could include the possibility that minorities are disproportionately enrolled in lower-cost health plans that put greater per-patient limits on healthcare spending and available services), and incentives to physicians to limit services. Where minority patients tend to receive care is also important to consider, as they are less likely to access care in a private physician's office, even when insured at the same level as whites. When asked why the healthcare system treats people unfairly based on race or ethnic background, 58% of physicians cite as a major reason the simple fact that many people from minority groups live in medically underserved areas where there are fewer doctors or other health providers.
- Physician biases and patient perceptions: Medical school does an excellent job of teaching the diagnosis and treatment of clinical disease but fails to prepare future physicians to incorporate psychosocial and cultural factors and overcome personal biases in the care of patients. It is reasonable to assume that the majority of healthcare provides find prejudice morally wrong and at odds with their professional values, but healthcare providers, like other members of society, may not recognize manifestations of prejudice in their own behavior. A study based on actual clinical encounters done by van Ryn and Burke (2000) found that doctors rated black patients as less intelligent, less educated, more likely to abuse drugs and alcohol, more likely to fail to comply with medical advice, more likely to lack social support, and less likely to participate in cardiac rehabilitation than white patients, even after patients' income, education, and personality characteristics were taken into account. These findings suggest that while the relationship between race or ethnicity and treatment decisions is complex, providers' perceptions and attitudes toward patients are often influenced in subtle ways by patient race or ethnicity.
- Greater clinical uncertainty when interacting with minority patients: Any degree of uncertainty a physician may have relative to the condition of a patient can contribute to disparities in treatment. In order to make a diagnosis, a doctor must depend on inferences about severity based on what they can see about the illness and on what they observe about the patient (including race, age, gender, and sometimes socioeconomic status). If the information related to the illness is lacking or deemed to be inaccurate, the doctor tends to rely on his observations of the patient (which may include unfair assumptions) to make diagnostic decisions. The consequence is that treatment decisions and patients' needs are potentially less well matched.
Sources: The National Healthcare Disparities Report, Agency for Healthcare Research and Quality (AHRQ) and U.S. Dept. of Health &and Human Services (July 2003) (accessed December 9, 2004); The Right to Equal Treatment Report, Physicians for Human Rights, (September 2003) (accessed December 9, 2004); and "Racial and Ethnic Disparities in Access to Health Insurance and Health Care," UCLA Center for Health Policy Research and The Henry J. Kaiser Family Foundation (April 200) (accessed December 9, 2004)