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From page 1... ... Summary ABSTRACT Racial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities, even when access-related factors, such as patients' insurance status and income, are controlled. The sources of these disparities are complex, are rooted in historic and contemporary inequities, and involve many participants at several levels, including health systems, their administrative and bureaucratic processes, utilization managers, healthcare professionals, and patients. Read the entire page →
From page 2... ... 2 UNEQUAL TREATMENT base decisions about resource allocation on published clinical guidelines, insure that physician financial incentives do not disproportionately burden or restrict minority patients' access to care, and take other steps to improve access -- including the provision of interpretation services, where community need exists. Economic incentives should be considered for practices that improve provider-patient communication and trust, and reward appropriate screening, preventive, and evidence-based clinical care. Read the entire page →
From page 3... ... 3 SUMMARY or to undergo coronary artery bypass surgery (e.g., Ayanian et al., 1993; Hannan et al., 1999; Johnson et al., 1993; Petersen et al., 2002) , are less likely to receive peritoneal dialysis and kidney transplantation (e.g., Epstein et al., 2000; Barker-Cummings et al., 1995; Gaylin et al., 1993) Read the entire page →
From page 4... ... 4 UNEQUAL TREATMENT Clinical Appropriateness and Need Patient Preferences Difference The Operation of Quality of Health Care Healthcare Systems and Non-Minority Legal and Regulatory Climate Disparity Discrimination: Minority Biases, Stereotyping, and Uncertainty FIGURE S-1 Differences, disparities, and discrimination: Populations with equal access to healthcare. SOURCE: Gomes and McGuire, 2001. Read the entire page →
From page 5... ... 5 SUMMARY EVIDENCE OF HEALTHCARE DISPARITIES Evidence of racial and ethnic disparities in healthcare is, with few exceptions, remarkably consistent across a range of illnesses and healthcare services. These disparities are associated with socioeconomic differences and tend to diminish significantly, and in a few cases, disappear altogether when socioeconomic factors are controlled. Read the entire page →
From page 6... ... 6 UNEQUAL TREATMENT health service categories, including diabetes care (e.g., Chin, Zhang, and Merrell, 1998) , end-stage renal disease and kidney transplantation (e.g., Epstein et al., 2000; Kasiske, London, and Ellison, 1998; Barker-Cummings et al., 1995; Ayanian et al., 1999) Read the entire page →
From page 7... ... 7 SUMMARY inequality, and evidence of persistent racial and ethnic discrimina tion in many sectors of American life. ASSESSING POTENTIAL SOURCES OF DISPARITIES IN CARE The studies cited above suggest that a range of patient-level, providerlevel, and system-level factors may be involved in racial and ethnic healthcare disparities, beyond access-related factors. Read the entire page →
From page 8... ... 8 UNEQUAL TREATMENT ences in response to drug therapy, however, are not due to "race" per se but can be traced to differences in the distribution of polymorphic traits between population groups (Wood, 2001) , and are small in relation to the common benefits of most therapeutic interventions. Read the entire page →
From page 9... ... 9 SUMMARY minority communities (Leigh, Lillie-Blanton, Martinez, and Collins, 1999) Read the entire page →
From page 10... ... 10 UNEQUAL TREATMENT The Implicit Nature of Stereotypes A large body of research in psychology has explored how stereotypes evolve, persist, shape expectations, and affect interpersonal interactions. Stereotyping can be defined as the process by which people use social categories (e.g., race, sex) Read the entire page →
From page 11... ... 11 SUMMARY ity of care for minority patients, research suggests that healthcare providers' diagnostic and treatment decisions, as well as their feelings about patients, are influenced by patients' race or ethnicity. Schulman et al. Read the entire page →
From page 12... ... 12 UNEQUAL TREATMENT stereotypic constellations. These conditions of time pressure, resource constraints, and the need to rely on gestalts map closely onto those factors identified by social psychologists as likely to produce negative outcomes due to lack of information, to stereotypes, and to biases (van Ryn, 2002) Read the entire page →
From page 13... ... 13 SUMMARY INTERVENTIONS TO ELIMINATE RACIAL AND ETHNIC DISPARITIES IN HEALTHCARE Legal, Regulatory, and Policy Interventions "De-Fragmentation" of Healthcare Financing and Delivery Racial and ethnic minorities are more likely than whites to be enrolled in "lower-end" health plans, which are characterized by higher per capita resource constraints and stricter limits on covered services (Phillips et al., 2000) Read the entire page →
From page 14... ... 14 UNEQUAL TREATMENT which they are enrolled and the relative lack of providers located in minority communities. Health systems should attempt to ensure that every patient, whether insured privately or publicly, has a sustained relationship with an attending physician able to help the patient effectively navigate the healthcare bureaucracy. Read the entire page →
From page 15... ... 15 SUMMARY Recommendation 5-4: Apply the same managed care protections to publicly funded HMO enrollees that apply to private HMO enrollees. Civil Rights Enforcement Enforcement of regulation and statute is also an important component of a comprehensive strategy to address healthcare disparities, but unfortunately has been too often relegated to low-priority status. Read the entire page →
From page 16... ... 16 UNEQUAL TREATMENT and standards directly promote accountability, they also indirectly affect equity of care. In actual practice, however, a pragmatic balance must be sought between the advantages and limitations of guidelines, such as the tension between the goal of standardization versus the need for clinical flexibility. Read the entire page →
From page 17... ... 17 SUMMARY Recommendation 5-7: Structure payment systems to ensure an ad equate supply of services to minority patients and limit provider incentives that may promote disparities. Recommendation 5-8: Enhance patient-provider communication and trust by providing financial incentives for practices that reduce barriers and encourage evidence-based practice. Read the entire page →
From page 18... ... 18 UNEQUAL TREATMENT 1999; Jackson and Parks, 1997) Read the entire page →
From page 19... ... 19 SUMMARY tients' skills and knowledge of clinical encounters and improve their participation in care decisions. Recommendation 5-12: Implement patient education programs to increase patients' knowledge of how to best access care and partici pate in treatment decisions. Read the entire page →
From page 20... ... 20 UNEQUAL TREATMENT Summary of Recommendations General Recommendations Recommendation 2-1: Increase awareness of racial and ethnic disparities in healthcare among the general public and key stakeholders. Recommendation 2-2: Increase healthcare providers' awareness of dispari ties. Read the entire page →
From page 21... ... 21 SUMMARY Recommendation 5-10: Support the use of community health workers. Recommendation 5-11: Implement multidisciplinary treatment and pre ventive care teams. Read the entire page →
From page 22... ... 22 UNEQUAL TREATMENT efforts are scattered and unsystematic, and many health plans, with a few notable exceptions, do not collect data on enrollees' race, ethnicity, or primary language. A number of ethical, logistical, and fiscal concerns present challenges to data collection and monitoring, including the need to protect patient privacy, the costs of data collection, and resistance from healthcare providers, institutions, plans and patients. Read the entire page →
From page 23... ... 23 SUMMARY Recommendation 8-1: Conduct further research to identify sources of racial and ethnic disparities and assess promising intervention strategies. Recommendation 8-2: Conduct research on ethical issues and other barriers to eliminating disparities. Read the entire page →
From page 24... ... 24 UNEQUAL TREATMENT Carrasquillo O, Orav EJ, Brennan TA, Burstin HR. Read the entire page →
From page 25... ... 25 SUMMARY Herholz H, Goff DC, Ramsey DJ, Chan FA, Ortiz C, Labarthe DR, Nichaman MZ. Read the entire page →
From page 26... ... 26 UNEQUAL TREATMENT Lillie-Blanton M, Martinez RM, Salganicoff A Read the entire page →
From page 27... ... 27 SUMMARY Shapiro MF, Morton SC, McCaffrey DF, Senterfitt JW, Fleishman JA, Perlman JF, Athey LA, Keesey JW, Goldman DP, Berry SH, Bozette SA. Read the entire page →

From page 1...

... Summary ABSTRACT Racial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities, even when access-related factors, such as patients' insurance status and income, are controlled. The sources of these disparities are complex, are rooted in historic and contemporary inequities, and involve many participants at several levels, including health systems, their administrative and bureaucratic processes, utilization managers, healthcare professionals, and patients.