America’s ‘Two-Tiered’ Health Care System Shortchanges Minorities, Women, Journal-Sentinel Reports
In an April 16 feature story on disparities in health care, the Milwaukee Journal-Sentinel reported that in America's "two-tiered" health care system, "institutionalized racism" affects the quality of care minorities and women receive. In addition to offering anecdotal evidence, the Sentinel cited studies and reports from the American Heart Association, the Archives of Internal Medicine, the Annals of Internal Medicine and Archives of Surgery among others to illustrate that women and minorities have difficulty receiving "competent, timely, aggressive, rock-solid medical care." For example, a 1999 report presented at a meeting of the American Heart Association found that physicians were more likely to diagnose a white man with heart disease than a black woman, although the patients "identically described" their symptoms. In addition, the Journal-Sentinel reports that white men are less likely than minorities to have legs amputated because of complications from diabetes; more likely than minorities to receive "adequate" treatment of pain; and experience shorter waits for organ transplants than do women and minorities. The Journal-Sentinel reported other evidence of "separate and unequal" care, including:
- Cancer treatment: A study of 11,000 Medicare patients found that 77% of white participants received "potentially curative treatment" for early stage lung cancer compared to 64% of blacks.
- Heart disease: The journal Stroke reported that 4% of black patients are recommended for heart surgery, compared to 18% of whites. In addition, women are half as likely as men to receive aspirin, other drugs, catheters or bypass surgery.
Action Needed
A primary contributor to health treatment disparities is providers' lack of "cultural competence" or understanding of minority or ethnic patients, which is caused in part by an "underrepresent[ation]" of minorities at medical schools, the Journal-Sentinel reports. Only 3% of the nation's physicians are black, and last year, only 7% of medical school applicants were minorities. Marian Gornick of the Georgetown Public Policy Institute said that the cultural disparities between providers and patients are "growing," adding, "They are greater today than ... they were when Medicare started" in 1965. However, the Journal-Sentinel reports that "impatience" with the situation also is increasing and more funds are being spent to "close the gap" between the care received by white men and "the lower-shelf brand of medical care too often received by everyone else." John Eisenberg, an administrator at the Agency for Health Care Policy and Research, said, "It is not enough any more to just measure the problem. We have to get beyond the gee whiz, isn't it a shame that blacks get less service than whites.' We have to convert it to changing our practice" (Rosenberg, Milwaukee Journal Sentinel, 4/15).