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Clinical Uncertainty and Healthcare Disparities

Published online by Cambridge University Press:  06 January 2021

Ana I. Balsa ,
Naomi Seiler ,
Thomas G. McGuire  and
M. Gregg Bloche
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Extract

The Institute of Medicine Report, Unequal Treatment: Confronting Racial and Ethnic Disparities, affirms in its first finding: “Racial and ethnic disparities in healthcare exist and, because they are associated with worse outcomes in many cases, are unacceptable.” The mechanisms that generate racial and ethnic disparities in medical care operate at the levels of the healthcare system and the clinical encounter. Research demonstrates the role of healthcare system factors, including differences in insurance coverage and other determinants of healthcare access, in producing disparities. Research also shows, however, that even when insurance status and other measures of access are controlled for by statistical methods, racial and ethnic disparities persist. These disparities remain when researchers try by various methods to control for patients’ clinical characteristics. Disparities are especially well documented through comparisons between white patients and African Americans and Latinos, but they are believed to affect other minority groups. As a result, many members of minority racial and ethnic groups receive less or inferior care.

Type
Research Article
Information
American Journal of Law & Medicine , Volume 29 , Issue 2-3 , June 2003 , pp. 203 - 219
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 2003

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Footnotes

†

Research for this Article was partly supported by grant P01 MH59876 from the NIMH (Balsa and McGuire), a Greenwall Fellowship (Seiler) and a Robert Wood Johnson Investigator Award in Health Policy Research (Bloche). McGuire and Bloche were members of the Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care.

References

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48 Even if the prevalence or outcome statistics on which a provider relies are accurate, these adjustments might contribute to clinically irrational disparities in health status. Bowser argues that providers’ reliance on differential prevalence (and outcome) data for different ethnic groups creates a sense of “these people just don't do well” that contributes to continued under-treatment or undervaluation of minority patients’ well-being. Bowser, Rene, Racial Bias in Medical Treatment, 105 DICK. L. REV. 365 (2001)Google Scholar.

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