“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
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. Consistent with the charge, the study committee focused part of its analysis on the clinical encounter itself, and found evidence that stereotyping, biases,
and uncertainty on the part of healthcare providers can all contribute to unequal
treatment. The conditions in which many clinical encounters take place—characterized by high time pressure, cognitive complexity, and pressures for cost containment—may enhance the likelihood that these processes will result in care
poorly matched to minority patients’ needs. Minorities may experience a range
of other barriers to accessing care, even when insured at the same level as whites,
including barriers of language, geography, and cultural familiarity. Further,
financial and institutional arrangements of health systems, as well as the legal,
regulatory, and policy environment in which they operate, may have disparate
and negative effects on minorities’ ability to attain quality care.
Despite changes in politics, health policy and
administration; reforms in health professions education and research;
restructuring of old along with the addition of new delivery systems; and
major healthcare and health system financing changes, the U.S. healthcare
system has had great difficulty shedding its racial-, ethnic-, class-, and
gender-based tiering, hierarchies, and almost reflexively discriminatory
medical-social culture (Byrd and Clayton, 2000, 2002; Farley, 1970; Farley
and Allen, 1989; Garrett, 2000; Morais, 1967; Smith, 1999; Stuart, 1987; U.S.
Commission on Civil Rights, 1999a).
SUMMARY 1
Abstract, 1
Study Charge and Committee Assumptions, 3
Evidence of Healthcare Disparities, 5
Racial Attitudes and Discrimination in the United States, 6
Assessing Potential Sources of Disparities in Care, 7
Interventions to Eliminate Racial and Ethnic Disparities in
Healthcare, 13
Data Collection and Monitoring, 21
Needed Research, 22
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