Minorities Get Inferior Care, Even If Insured, Study Finds (2001)
Sheryl Gay Stolberg
WASHINGTON, March 20 -
Racial and ethnic minorities in the United States receive lower quality
health care than whites, even when their insurance and income are the
same, say a panel of scientific experts who termed their study a wake-up
call to the nation's doctors.
The study, made public today by the Institute of Medicine, an
independent research institution that advises Congress, is the first
comprehensive look at racial disparities in health care among people who
have health insurance.
While the so-called race gap in medicine has been well-documented,
previous research has attributed much of the problem to lack of access
to care. The panel cited subtle racial prejudice and differences in the
quality of health plans as possible reasons why even insured members of
minorities get worse care.
"The differences are pervasive," said Martha N. Hill, director of the
Center for Nursing Research at Johns Hopkins University School of
Nursing, and the co-vice chairwoman of the panel. "It cuts across all
conditions of health and across the entire country, and we think this is
a very serious moral issue."
Saying they were deeply troubled by the findings, the authors made
recommendations that included additional research to understand how bias
affects care, efforts to increase the number of minority doctors, and
the use of interpreters to ease communication between physicians and
patients who do not speak English.
The report, which reviewed more than 100 studies conducted over the last
decade, concluded that the
disparities contribute to higher death rates among minorities from
cancer, heart disease, diabetes and
It found that members of minorities were less likely to be given
appropriate medications for heart disease, or to undergo bypass surgery,
and are less likely to receive kidney dialysis or transplants than
whites. They are also less likely to receive the most sophisticated
treatments for infection with H.I.V.,
which could delay the onset of AIDS.
But members of minorities are more likely to receive certain less
desirable procedures. The committee cited a study of Medicare
beneficiaries, for instance, that found blacks were 3.6 times as likely
as whites to have their lower limbs amputated as a result of diabetes.
"Some of us on the committee were surprised and shocked at the extent of
the evidence," said the chairman of the panel, Dr. Alan R. Nelson, a
former president of the American Medical Association. He
added, "The evidence is overwhelming."
But Claude Allen, the deputy secretary for health and human services,
said the findings did not surprise
federal health officials. Mr. Allen said today that the Bush
administration was continuing an initiative
begun under President Bill Clinton to erase disparities in medical care.
"We believe that education is the key, both education for providers to
be aware of the subjectivity of their
decisions and education for patients, to allow them to take control of
their health care decision making," he said.
The authors of the study offered multiple explanations for the
disparities, among them quality of insurance. Members of minorities are
more likely than whites to be enrolled in lower-end insurance plans that
impose stricter limits on medical services, and that require doctors to
see more patients, spending less time with each.
Yet the study found that differences persist even when minority and
white patients have the same insurance, in part because minority
patients are less likely than whites to have a long-lasting relationship
with a primary care physician.
Racial bias, albeit subconscious, may also be at work, the study found.
While the panel said most health providers were well-intentioned, it
cited "indirect evidence" that doctors' decisions were influenced by
their perceptions of race.
As an example, the authors cited a study of major medical centers in New
York State that found
African-Americans were 37 percent less likely to undergo angioplasty and
other heart procedures,
including bypass surgery, than whites. In 90 percent of the cases in
which the patient did not get the
surgery, the doctor had not recommended it.
In interviews with the doctors, the researchers found "classic negative
racial stereotypes," the report
said, such as assumptions that black patients would be less likely to
participate in follow-up care.
"This is a timely and powerful report," said Dr. Lucille C. Perez,
president of the National Medical
Association, which represents black doctors. "It validates what the
N.M.A. has been saying for so long - that racism is a major culprit in
the mix of health disparities, and has had a devastating impact on
A spokeswoman for the American Medical Association, the nation's largest
organization representing doctors, declined to comment on the findings,
saying its officials had not seen the study. In a policy
statement adopted in 1998, the medical association "encourages
physicians to examine their own practices to ensure that inappropriate
considerations do not affect their clinical judgment."
Although the medical literature is most complete on disparities between
African-Americans and whites, the report found the disparities also
extended to Hispanics.
Part of the problem, the report said, may be a lack of minority doctors.
Minorities, including African-Americans, Asian-Americans, Hispanics and
American Indians, account for just 9 percent of the
David R. Williams, a professor of sociology at the University of
Michigan who served on the panel, called
the report "a wake-up call" for doctors and patients. "We have a health
system that is the pride of the
world," Professor Williams said. "But this report demonstrates that the
playing field clearly is not