Washington's Voz - In health, some are more equal than others

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In health, some are more equal than others

Washington's Voz

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Isabel M. Estrada Portales
06/24/2005

Health disparities are the result of a complex mix of factors, but in essence they are defined by the answer to a simple question: why medical treatment is different for minorities and non-minorities when all other factors are the same?

“My name is… [a common Hispanic surname] and when they see that name, I think there is… some kind of a prejudice of the name… We're talking about on the phone, there's a lack of respect,” said a Hispanic focus group participant of a study conducted by the Institute of Medicine (IOM).

“There's a lack of acknowledging the person and making one feel welcome. All of the courtesies that go with the profession that they are paid to do are kind of put aside. They think they can get away with a lot because “Here's another dumb Mexican,” she remarks.

There are wide differences between racial and ethnic groups in access to health care and the availability of health insurance. Minorities, especially Hispanic and African-American families, are less likely than whites to have private health insurance.

“Or if they have insurance, minorities are more likely than whites to be enrolled in health plans that place tight limits on the types of services that patients may receive. Also, the best quality health care services and providers are not always found in minority communities,” the IOM study explains.

But recent medical research also shows that racial and ethnic minority patients tend to receive a lower quality of care than non-minorities, even when they have the same types of health insurance.

When compared with the overall US population, Latinos generally have lower mortality rates but higher morbidity rates; are almost twice as likely to die from diabetes; account for a disproportionate percentage of new cases of tuberculosis; and have higher rates of high blood pressure and obesity.

There are differences among Hispanic populations as well. For example, whereas the rate of low-birth-weight infants is lower for the total Latino population than for whites, the rate for Puerto Ricans is 50% higher than the rate for whites.

According to the IOM report, the way healthcare systems are organized and operate can contribute to differences. Sometimes healthcare systems, hospitals, or clinics adopt policies or practices that are based on good intentions – such as the need to contain healthcare costs – but may pose barriers to minority patients' ability to access care.

Some health plans offer financial incentives to physicians to keep costs low. Keeping healthcare costs down is important, but these policies may unintentionally hurt minorities, in that cost-savings may come at the expense of patients who are least educated about their treatment options and least likely to push their doctor for more services.

Another Hispanic focus group participant remembers his post surgery experience. “The doctor comes in and says, “Why is he on oxygen?” I was recovering from surgery. He's looking at the chart and he says, “The insurance doesn't cover it. Take it off.” Just like that. I'm right there, and I'm thinking “Wow, that's pretty harsh if it comes from a doctor.” That was unfair I thought.”