by Christopher Cornue

Our daily lives in healthcare are focused addressing crises that arise, managing our expenses, developing new growth opportunities through Service Lines, implementing new ground-breaking technology and the like. However, one area that many safety-net & inner-city hospitals confront on a daily basis is our ability to address disparities in healthcare. As reports and studies have demonstrated, this is becoming an increasingly difficult issue to address. In Chicago alone, there are many examples of groups and organizations that are leading efforts to address this. These will be discussed in upcoming posts. But first, what are disparities and how do they impact all of us?

General information suggests that by 2050, racial and ethnic minorities will account for 90% of our US population growth. As a result, there will be increasing racial and ethnic minorities seeking healthcare at our hospitals and health systems.

The Institute of Medicine’s groundbreaking 2003 book, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, brought to light, on an international scale, the issue of disparities in healthcare. Their argument is that “racial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities.” At the urging of Congress, the IOM conducted a study to assess the “differences in the kinds & quality of health care received by US racial and ethnic minorities and non-minorities.” Examples of disparities they found in their research were 1) overuse & underuse of treatments and services; and 2) mortality rates among difference racial & ethnic groups, among others.

Their analysis and assessment demonstrated that 1) evidence of racial and ethnic disparities is consistent among many illnesses and healthcare services; 2) they are associated with socioeconomic differences; and 3) these disparities, if adjusted for socioeconomic differences, often remain.

The following five findings provide the foundation for most initiatives working to address this issue, and are a sobering reminder to us of our call to action in our roles as healthcare leaders:

o Finding 1 – Racial and ethnic disparities in healthcare exist, and because they are associated with worse outcomes in many cases, are unacceptable.
o Finding 2 – Racial and ethnic disparities in healthcare occur in the context of broader historic and contemporary social and economic inequality, and evidence of persistent racial and ethnic discrimination in many sectors of American life;
o Finding 3 – Many sources (including health systems, healthcare providers, patients, etc.) may contribute to racial and ethnic disparities;
o Finding 4 – Bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare providers may contribute to racial and ethnic disparities in healthcare. While indirect evidence from several lines of research supports this statement, a greater understanding of the prevalence and influence of these processes is needed and should be sought through research;
o Finding 5 – A small number of studies suggest that racial and ethnic minority patients are more likely than white patients to refuse treatment. These studies find that differences in refusal rates are generally small and that the minority patient refusal does not fully explain healthcare disparities.

Next week, we’ll look at some nationwide initiatives that are attempting to address this significant issue in healthcare.

This post is part of a 5-part series on healthcare disparities:
- Part 1: Introduction to Healthcare Disparities
- Part 2: A few healthcare organization role models to follow
- Part 3: Measuring disparities meaningfully
- Part 4: Two big disparities projects in the works
- Part 5: Cardio in African-Americans and Hispanics