Equity

Background on Disparities in Healthcare

Disparities in healthcare in the United States are widespread and well documented. Multiple studies show that minorities are less likely to receive important healthcare services, including preventive services and regular physicals, as well as clinically appropriate interventions. They are also more likely to receive care from providers with fewer resources, lower qualifications, and less experience than whites. This disparate care results in less satisfaction with care, lower compliance with prescribed treatments, and poorer health outcomes for many minority Americans.

The poor quality of care provided to minority groups can be explained in part by failures in the healthcare system. Insurance status is a powerful predictor of healthcare use and type of provider seen, and minority groups are more likely to be uninsured than whites. Access problems, including geographic proximity to care and linguistic and cultural barriers, also hinder minority patients' ability to seek out high-quality care.

Disparities are not, however, solely a consequence of these system-level factors. Differences in care persist even when controlling for insurance status and access issues. Some researchers suggest that lower-quality care for minorities may be explained in part by patient preference, but the [Page 440]evidence is inconsistent, and the effect has been found to be small.

Given that patient preference cannot adequately explain disparities in care, researchers have begun to examine whether disparities emerge from the medical encounter and the process that physicians and patients go through to make important decisions about patients' health and healthcare. Provider bias in decision making, for example, can lead to disparate care for minorities. While providers resist believing that they provide disparate care, studies suggest that intentional and unintentional stereotyping and bias by race, ethnicity, and gender influence clinical decisions and lead to inferior care for minorities.

Poor communication, lack of information, and mistrust between patient and provider can influence patients' understanding of their health and the decisions they make regarding their care. Care for minority patients is often less patient centered than care for white patients, particularly when the patient-physician relationship is not racially or ethnically concordant. Minorities are less likely than whites to report that their physicians engage in participatory care and patient-centered communication and more likely to report that their physicians treat them with disrespect. Misunderstandings and a lack of culturally competent care on the part of the provider also contribute to disparate care.

A physician-patient interaction in which there is poor communication, bias, and mistrust is likely to result in uninformed decision making. Understanding and improving the decision-making process may mitigate some of these effects and substantially improve care for minority patients.

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