Discrimination And The Differential Quality Of Medical Care

In order to analyze this project objectively, research will be presented from various academic sources. The institute of medicine (IOM) has done extensive research, at the request of the United States Congress, on the various disparities within healthcare. Their analysis looks at differences in treatment, patient perception, and how individuals of different races and genders act while receiving care. Furthermore, I have out in an inquiry to St. Lukes Hospital, a member of the greater Lehigh Valley Heath Network, to see what type of data they may have on the disparities in healthcare amongst women of different races. The Lehigh Valley serves as a diverse data pool to extract meaningful information from. The demographic make-up of Bethlehem is varied, yet African Americans only account for roughly 6 percent of the population (Suburbanstats.org). The small size of the African American populations will need to be taken into account, but the information should still allow for valid data.

Being a minority in the United States has and will possibly always been a struggle. With the economy being in shams and minimum wage becoming career, minorities have multiple issues that society is unaware especially in health care. A large percent of minorities are the majority of workers of America, in which requires the most of the health care distribution. But are they receiving the proper access to health care and prescription access based on their ethnicity/race? Discrimination and racism continue to be a part of the unbalancing inequality in society and have adversely affected minority populations, and the health care system in general. Analyzing some of the racial disparities in health care among Americans are modifications in both need and access. Minorities are most likely to need health care but are less likely to receive health care services, including proper drug access.

With the increasing immigrant population a third barrier affecting access to health care is a cultural barrier. Culture barriers can include values and beliefs, language and race and ethnicity. Health beliefs and behavior can become a barrier when patients decide not to seek medical treatment and instead turn to home remedies and healers when treating illnesses. Approximately 10% of Americans speak a language other than English and can be classified ad being limited in their proficiency. For these patients language becomes a barrier and they are less likely to receive optimal medical treatment (Flores, 2006). Horton and Johnson (2010) stress the importance of communication in reducing disparities and increasing the trust of patients in the health care system. As reported by the American College of Physicians, evidence reveals that racial and ethnic minorities are more likely to receive inferior care when compared with non-minorities. This occurs even when minorities have access to insurance and adequate income (Racial and ethnic disparities in health care, 2010).

In doing so, he pays particularly close attention to black patients and their relations with health care policies and practices. Smedly maintains that blacks are not only the victims of, inpatient and outpatient treatment, racial policies, and other services but also the victims of its consequences. He argues that many health care administrators are agents to a system of inequality that support provider and administrator biases, geographical inequalities, and racial stereotypes (Smedly 2012).

Diversity means to value and respect the differences and individuality of people. This means to embrace the differences between people and to treat a person’s race, culture, religious beliefs, age, sexual orientation, gender, physical and mental characteristics etc. with respect.

Since the publication of the Institute of Medicine’s “Unequal Treatment Report” in 2002, highlighting the startling but harsh truths behind these health care differences, there has been a renewed interest in understanding the sources of these inconsistencies, with any seeking to identify contributing factors in hopes of creating an effective solution in reducing or eliminating racial and ethnic disparities in health care

The answer is no simple or a single solution. Rather, the answers must address the range of causes of disparities (inequalities in education, housing, and health insurance) and empower multiple levels of change ( patients, providers, health systems, policymakers, communities). These levels of change are most commonly found in the fundamental public health Socio-Ecological model. In this model, there are 5 levels, intrapersonal, interpersonal, community, institutions and policy, that could be focused on when implementing solutions to public health concerns, which health disparities would be considered. One method that should be looked at very closely in the institutional level of the model is reorganizing the curriculum of physician education in order to incorporate cultural competency. Such training can improve provider knowledge, attitudes and skills, which may be an important precursor to addressing unconscious provider bias. Drawing upon evidence in social cognitive psychology, Van Rhys Burgess have outlined strategies and skills for healthcare providers to prevent unconscious racial biases from influencing the clinical encounter. Their framework includes: 1) Enhancing internal motivation and avoiding external pressure to reduce bias, 2) Enhancing understanding of the psychosocial basis of bias, 3) Enhancing providers’ confidence in their

In 1964 Congress passed the Civil Rights Act in which Title VI specifically forbade the distribution of federal funds to organizations that practiced discrimination. Enforcement of Title VI was a major priority within the Johnson administration as they implemented the Medicare program (Reynolds, 1997). Despite a mandate of equal treatment, significant patterns of segregated health care utilization have remained to the present. In an analysis of Medicare beneficiaries, Bach and colleagues found that their was a small proportion of physicians – 22% - who provided the majority of visits - 80% - by black patients (Bach, Pham, Schrag, Tate, & Hargraves, 2004). This may represent a pattern of racial concordance, patients choosing providers of their own race, but the physicians seeing the majority of black patients did not the same resources available as those seeing the majority of white patients. Compared with physicians seeing the mostly white patients, physicians seeing mostly black patients were 33% less likely to report always having access to high quality specialists, and 40% less likely to report always having access to high quality diagnostic imaging. In short, black patients are using a different health system than white patients on average and the health system black patients are using has fewer resources (Bach, et al., 2004).

More Diverse Healthcare Professionals lead to positive patient outcomes. Racial and ethnic minorities have higher rates of poor health outcomes than white in the case of disease, even when income, employment status and insurance coverage are controlled. Cultural bias is one contributor to this, according to the IOM Report Unequal Treatment:

Although the United States is a leader in healthcare innovation and spends more money on health care than any other industrialized nation, not all people in the United State benefit equally from this progress as a health care disparity exists between racial and ethnic minorities and white Americans. Health care disparity is defined as “a particular type of health difference that is closely linked with social or economic disadvantage…adversely affecting groups of people who have systematically experienced greater social and/or economic obstacles to health and/or clean environment based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion” (National Partnership for Action to End Health Disparities [NPAEHD], 2011, p. 3). Overwhelming evidence shows that racial and ethnic minorities receive inferior quality health care compared to white Americans, and multiple factors contribute to these disparities, including geography, lack of access to adequate health coverage, communication difficulties between patients and providers, cultural barriers, and lack of access to providers (American College of Physicians,

In a perfect world, race, ethnicity and culture would have no negative effect on the medical care we receive, yet problems do arise and it affects the quality of care the patient receives. Language barrier, poor socioeconomic status, and poor health literacy also contribute to health care disparity. For Lia, it was more than her skin color, it was all of the above, her parents did not speak English and they were illiterate. They had trouble understanding the American healthcare system, had trouble or little interest in adjusting to or understanding the American culture. They didn’t work, which in addition to cross cultural misunderstanding, helped contribute to animosity between the Hmong and the host community, because some in the Merced area did not like or appreciate the fact that some Hmong did not work and relied on welfare to make ends meet. All these factors, contributed to the poor quality of

One of the points raised in IOM’s article to prove that racism is a prevalent cause of health care disparity is the way the health care system is set-up, meaning at times, some hospitals and clinics can adopt a policy to contain health care cost, but may pose hindrances to minority patients’ capability to access the care.

Personal and institutional relationships may be affected by concerns of continued discrimination against African Americans who have historically been victims of both interpersonal and institutional racial discrimination (LaVeist & Nuru-Jeter, 2002). Research demonstrated that concordance in patient and physician race is positively related to African Americans perceptions of quality of care. Patient satisfaction supports the notion that fear of race-based discrimination in interpersonal relationships with health care providers may also affect trust (Cooper, Gallo, Gonzales, Vu, Powe, Nelson & Ford, 1999; LaVeist, 2002). African Americans had been shown to have greater awareness of the documented history of racial discrimination in the health care system than white Americans.

In the last twenty years, the rising number of disparities in health and healthcare has increased simultaneously with the influx of minorities within the population (Baldwin, 2003) A4. As the size of an ethnically diverse population steadily continues to increase, so will the level of complexities of patients’ health needs, which nurses and other healthcare staff will be expected to address (Black, 2008) A1. The issue of racial, ethnic and health disparities for minorities exists for several complex reasons, however, even with this being widely known, very little action has been taken to try and correct it (Baldwin, 2003) A4. Research findings suggest that without actively implementing cultural diversity within the healthcare workforce, quality in healthcare will decline while health disparities continue to rise (Lowe & Archibald, 2009) A3. So although the shortage of nursing staff should be a high-priority for change in the U.S., the need for more registered nurses with racially

Discrimination can effect children in many different ways and sometimes you can find yourself judging someone without knowing anything about that certain person.