The Institute of Medicine, an independent research institution, released a 562-page report with extensive analysis of the widespread disparities in health care among different racial and ethnic groups. The report, which was requested by Congress, showed a comprehensive review of more than 100 studies conducted over the past decade. The panel of scientific experts involved in the study concluded that racial and ethnic minorities receive lower-quality health care than whites even in cases of equal income and insurance plans.
The racial disparities in health care among people with similar health insurance are well-documented; the obvious race gap in medicine challenged previous research that attributed the problem to lack of access to care. The panel revealed that subtle racial prejudice is a possible reason why insured members of the minority get inferior care.
Martha N. Hill, director of the Center for Nursing Research at Johns Hopkins University School of Nursing and the vice chairman of the panel, is concerned about the health care system, "The difference is a pervasive problem with moral and ethical implications for our society."
The entire panel recommended further research to understand how prejudice affects health care, the increase in minority doctors, and the use of interpreters to expedite communication between doctors and patients of another language. Martha speaks on behalf of the panel, "It cuts across all conditions of health and across the entire country, and we think this is a very serious moral issue."
The panel found that the inequalities in medical care contribute to higher death rates among minorities of cancer, diabetes, heart disease and H.I.V. infection because minorities were not likely to be given proper treatment. The studies indicate that minorities were less likely to receive medication for cardiovascular disease, to undergo bypass surgery or transplants, to be offered appropriate procedures that would delay AIDS. Furthermore, the members of minorities were more likely to receive procedures that are usually avoided.
The panel pointed to a study of Medicare beneficiaries that found black people were 3.6 times more likely than white people to have an amputation as a result of diabetes.
A study of 13,000 New Jersey heart patients showed that patients with the same symptoms were given uneven care; catheterization to clear the arteries was not a common procedure among African Americans.
Another study of 13,600 nursing home residents claimed that blacks "had a 63 percent greater probability of being untreated for pain relative to whites."
"Some of us on the committee were surprised and shocked at the extent of the evidence. The evidence is overwhelming," said Dr. Alan R. Nelson, chairman of the panel and a former president of the American Medical Association.
The insurance available to members of the minorities imposes stricter limits and covers less medical services. Even when the minority and white patients have the same insurance, the minority patients spend less time with the physicians. The panel believes that while the doctors mean well, their decisions were influenced by subconscious racial prejudice.
"This is a timely and powerful report. It validates what the N.M.A. has been saying for so long that racism is a major culprit in the mix of health disparities, and has had a devastating impact on African-Americans," said Dr. Lucille C. Perez, president of the National Medical Association.
A study of a large medical center in New York State found that African-Americans were 37 percent less likely to receive angioplasty and other heart procedures than whites. The doctors had not recommend surgery to 90 percent of the patients who did not go through the appropriate surgery. After interviews with doctors, the panel found that "classic negative racial stereotypes" do affect the doctors' decisions. Physicians appear to be hesitant about suggesting procedures to patients because of the common assumption that black patients are not as likely to engage in follow-up treatments.
"Physicians and other health care providers are more comfortable interacting with people like themselves-highly educated, articulate individuals. Providers go into health care professions with good intentions, yet the evidence goes suggest there is unequal treatment," said committee member Risa Livizzo-Mourey, senior vice president of the Robert Wood Johnson Foundation.
A spokesperson for the American Medical Association, the nation's largest organization representing doctors, refused to comment on the findings since its officials had not seen the report. Nevertheless, according to the policy statement adopted in 1998, the medical association "encourages physicians to examine their own practices to ensure that inappropriate considerations do not affect their clinical judgment."
The report also identified that part of the problem is the lack of minority doctors. African-Americans, Asian-Americans, Hispanics and American Indians account for nine percent of the nation's doctors. "We have a health system that is the pride of the world. But the playing field is clearly not level," said David R. Williams, a professor of sociology at the University of Michigan who served on the panel.
The mounting evidence of medical treatment disparity is attracting attention and attempts to address the problem. Claude Allen, the deputy secretary for health and human services, said that the federal health officials have already launched efforts to remove disparities in medical care; the Bush administration was following up on an endeavor begun under the Clinton administration.
"We believe that education is the key, both education for providers to be aware of the subjectivity of their decisions and education for patients, to allow them to take control of their health care decision making," said Mr. Allen.
