Minorities Receive Lower Quality of Care Than Whites, New Institute of Medicine Report Finds
Minorities in America generally receive poorer health care than whites, even when income, insurance and medical conditions are similar, according to a comprehensive report released yesterday by the Institute of Medicine. The Philadelphia Inquirer reports that the 15-member IOM panel found that this inequality has led to higher minority death rates from a host of chronic conditions (Pugh, Philadelphia Inquirer, 3/21). "Within the committee itself, we were amazed, surprised and shocked at the evidence of disparities," Dr. Alan Nelson, former president of the American Medical Association and chair of the committee, said (Ackerman, Houston Chronicle, 3/21). Although the problem of racial and ethnic disparities in the U.S. health care system is well-documented, the IOM study is the first to account for income and insurance as well as race, age and other factors, according to Joseph Betancourt, a lead researcher on the committee from the Institute for Health Policy at Massachusetts General Hospital-Harvard Medical School (Galarza, Los Angeles Times, 3/21). The report, based on a review of more than 100 studies conducted over the past decade, included the following findings:
- Minorities were less likely than whites to receive appropriate treatment for heart disease, to undergo bypass surgery and to receive kidney dialysis or transplants (Stolberg, New York Times, 3/21). The biggest discrepancies -- and the "most devastating health consequences" -- were found in the areas of cardiovascular disease, HIV/AIDS, cancer and diabetes (Connolly, Washington Post, 3/21).
- According to a 1991 study of 4,154 Medicare claims, 12.5% of black prostate cancer patients received no treatment for their condition, compared to 6.6% of whites with prostate cancer (Pelton, Baltimore Sun, 3/21).
- A study of 15,578 people nationwide who sought care in emergency rooms found that blacks were 1.5 times more likely than whites to be denied authorization by their managed care plans (Ricks, Newsday, 3/21).
- A 1992 study of 86,000 Medicare beneficiaries found that blacks were four times less likely to receive needed coronary bypass surgery than whites (Baltimore Sun, 3/21).
- Another study of Medicare beneficiaries found that blacks were 3.6 times more likely than whites to have their lower limbs amputated as a result of diabetes (New York Times, 3/21).
The 562-page report identified several reasons for the disparities, including language barriers, inadequate coverage, provider bias and a lack of minority doctors (Washington Post, 3/21). The committee said that minorities are more likely to be in "lower-end insurance plans" with greater limits on medical treatments and less access to doctors. But even when coverage is comparable between minorities and whites, health discrepancies remain, in part because the former are less likely to have a long-term relationship with a primary care physician, the report found (New York Times, 3/21). Researchers also said that bias among doctors and nurses, while not necessarily overt, contributes to health disparities and can foster distrust among minority patients that exacerbates the problem. "The stereotyping process is an unconscious process and an automatic process," David Williams, a member of the committee and professor of sociology at the University of Michigan, said, adding, "Many individuals who ... are committed to egalitarian values will nevertheless unconsciously treat minority patients differently" (Baltimore Sun, 3/21). The report also found that minorities are "far more likely" to be treated by a white doctor who makes less money and received less training than other providers and who does not fully understand a patient's native language or culture. In addition, the percentage of black physicians in the United States has only increased from 3.5% to 3.9% over the past three decades. While the report found that some minority patients refused treatment or tests, it was more likely that doctors' failure to present treatment options clearly or minorities' need to make health care choices based on cost were greater factors in creating disparities (Washington Post, 3/21).
The report offered several recommendations for reducing disparities, including increasing provider education about various cultures. Claude Allen, HHS deputy secretary, also called for improved patient education "to allow them to take control of their health care decision making" (New York Times, 3/21). The report called for medical schools to educate more minority doctors (Baltimore Sun, 3/21). In addition, the committee recommended greater funding for the HHS Office of Civil Rights, saying, "The agency is charged with enforcing laws that prohibit discrimination in health care, but in recent years funding has been insufficient to adequately investigate complaints" (Fox, Reuters/Newark Star-Ledger, 3/21). Other recommendations include better data collection on minority patient care, more use of language translators and more research on provider bias (Philadelphia Inquirer, 3/21).
The IOM report is at least the fourth study showing racial disparities in the health care system to be released this year. A January CDC report found that although the health gap between whites and minorities narrowed in the 1990s, substantial disparities remain (California Healthline, 1/25). A Commonwealth Fund survey released earlier this month found that minorities do not fare as well as whites on almost every measure of health care quality (California Healthline, 3/7). And a Harvard study released earlier this month found that black patients enrolled in Medicare+Choice plans receive poorer quality of care than white patients across several measures (California Healthline, 3/13). The new report may carry more weight -- and receive more attention -- because it was written by the IOM, an "influential arm" of the National Academy of Sciences, the Hartford Courant reports. "It raises health care disparities to the same level as medical errors," Commonwealth Fund Vice President Karen Collins said, referring to a 1999 IOM report that brought that issue to public attention (MacDonald, Hartford Courant, 3/21). Rep. Jesse Jackson Jr. (D-Ill.), who requested the report, said, "Racial and ethnic disparities are a major problem throughout America. If we're to make progress in this high-priority area, we must have a road map that the IOM has the credibility to provide" (Sternberg, USA Today, 3/21).
The full report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care," is available online. In addition, a PBS' "Newshour with Jim Lehrer" report on the study is available online.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.