Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (with CD)

Overview

Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment ...

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Overview

Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients and providers attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross- cultural education to improve provider patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.

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Product Details

  • ISBN-13: 9780309215824
  • Publisher: National Academies Press
  • Publication date: 2/6/2009
  • Edition description: New Edition
  • Pages: 432
  • Sales rank: 787,217
  • Product dimensions: 6.00 (w) x 8.90 (h) x 1.20 (d)

Table of Contents

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

1 Introduction and Literature Review 29

Study Charge and Committee Assumptions 30

The Relationship Between Racial and Ethnic Disparities in Health Status and Healthcare 35

Why are Racial and Ethnic Disparities in Healthcare Important? 36

Evidence of Racial and Ethnic Disparities in Healthcare 38

Summary 77

2 The HealthcareEnvironment and its Relation to Disparities 80

The Health, Health Insurance, and Language Status of Racial and Ethnic Minority Populations 81

Racial Attitudes and Discrimination in the United States 90

The Context of Healthcare Delivery for Racial and Ethnic Minority Patients—An Historical Overview 102

A Brief History of Legally Segregated Healthcare Facilities and Contemporay De Facto Segregation 103

The Settings in Which Racial and Ethnic Minorities Receive Healthcare 108

The Healthcare Professions Workforce in Minority and Medically Underserved Communities 114

The Participation of Racial and Ethnic Minorities in Health Professions Education 120

Summary 123

3 Assessing Potential Sources of Racial and Ethinic Disparities in Care: Patient- and System-Level Factors 125

A Model: Sources of Healthcare Disparities 126

Patient-Level Variables—Preferences, Mistrust, Treatment Refusal, Biological Differences, and Overuse of Services 131

Health Systems-Level Variables 140

Summary 159

4 Assessing Potential Sources of Racial and Ethnic Disparities in Care: The Clinical Encounter 160

Medical Decisions Under Time Pressure with Limited Information 161

Healthcare Provider Prejudice or Bias 162

Patient Response: Mistrust and Refusal 174

Conclusion 175

5 Interventions: Systemic Strategies 180

Legal, Regulatory, and Policy Interventions 181

Health Systems Interventions 188

Patient Education and Empowerment 196

6 Interventions: Cross-Cultural Education in the Health Professions 199

Background 199

Cross-Cultural Communication: Links to Racial/Ethnic Disparities in Healthcare 200

The Foundation and Emergence of Cross-Cultural Education 201

Approaches to Cross-Cultural Education 203

Summary 212

7 Data Collection and Monitoring 215

Obstacles to Racial/Ethnic Data Collection 217

The Federal Role in Racial, Ethnic, and Primary Language Health Data 219

Other Data Sources to Assess Healthcare Disparities 223

Models of Measuring Disparities in Healthcare 226

Data Needs and Recommendations 232

8 Needed Research 235

Understanding Clinical Decision-Making and the Roles of Stereotyping, Uncertainty, and Bias 236

Understanding Patient-Level Influences on Care 237

Understanding the Influence of Healthcare Systems and Settings on Care for Minority Patients 237

Understanding the Roles of Non-Physician Health Professions 239

Assessing Healthcare Disparities Among Non-African American Minority Groups 240

Assessing the Effectiveness of Intervention Strategies 240

Developing Methods for Monitoring Healthcare Disparities 241

Understanding the Contribution of Healthcare to Health Outcomes and the Health Gap Between Minority and Non-Minority Americans 241

Mechanisms to Improve Research on Healthcare Disparities 242

References 244

Appendixes

A Data Sources and Methods 271

B Literature Review 285

C Federal-Level and Other Initiatives to Address Racial and Ethnic Disparities in Healthcare 384

D Racial Disparities in Healthcare: Highlights from Focus Group Findings 392

E Committee and Staff Biographies 406

Paper Contributions

Racial and Ethnic Disparities in Diagnosis and Treatment: A Review of the Evidence and a Consideration of Causes H. Jack Geiger 417

Racial and Ethnic Disparities in Healthcare: A Background and History W. Michael Byrd Linda A. Clayton 455

The Rationing of Healthcare and Health Disparity for the American Indians/Alaska Natives Jennie R. Joe 528

Patient-Provider Communication: The Effect of Race and Ethnicity on Process and Outcomes of Healthcare Lisa A. Cooper Debra L. Roter 552

The Culture of Medicine and Racial, Ethnic, and Class Disparities in Healthcare Mary-Jo DelVecchio Good Cara James Byron J. Good Anne E. Becker 594

The Civil Rights Dimension of Racial and Ethnic Disparities in Health Status Thomas E. Perez 626

Racial and Ethnic Disparities in Healthcare: Issues in the Design, Structure, and Administration of Federal Healthcare Financing Programs Supported Through Direct Public Funding Sara Rosenbaum 664

The Impact of Cost Containment Efforts on Racial and Ethnic Disparities in Healthcare: A Conceptualization Thomas Rice 669

Racial and Ethnic Disparities in Healthcare: An Ethical Analysis of When and How They Matter Madison Powers Ruth Faden 722

Index 739

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