Narrowing the Gap: Disparities in Health Care

MMS Physician Focus: January 2006
By Alice A. Coombs, M.D.

Four years ago this March, the prestigious Institute of Medicine issued a landmark report titled Unequal Treatment, Confronting Racial and Ethnic Disparities in Healthcare

The report created a stir across the country and touched a nerve in the medical community. It pointed out that racial and ethnic minorities receive poorer quality medical care than white patients, even when such factors as insurance coverage, ability to pay, and access to care were equal among the groups.

The IOM identified several causes of these disparities. Minorities generally face bigger gaps in access to care, because they're less likely to have private health insurance and because quality health care services are not always found in minority communities.

Further, physicians and health care providers make many decisions for all patients with a degree of uncertainty related to a patient's diagnosis, options for treatment, or potential side effects of a prescribed treatment. Such uncertainty poses challenges for any doctor trying to find the right treatment for a patient. But when faced with patients from different racial or ethnic backgrounds, doctors can find their uncertainty is greater. Also, health care may be impeded because of a lack of a cultural understanding of particular groups on the part of the physician or provider.

Provider-patient relationships can also be affected by attitudes and behavior. Some evidence exists that minority patients may not trust health care professionals, thus leading to delays in seeking treatment or avoiding screening tests that could provide early warning signs of disease. Other major concerns are the lack of translation services for those who don't speak English and a lack of communication between physician and patient -- many doctors use medical terms that patients find hard to understand.

With a myriad of causes, and the significant impact it has on minority groups, eliminating health care disparity has become a top priority for the medical community and policymakers alike on national and statewide levels.

The good news is that progress is being made. Health care providers, insurers, hospitals, legislators, and policymakers are all recognizing that disparities do exist and that they must be eliminated. The City of Boston and the Commonwealth of Massachusetts and groups like the American Medical Association are devoting substantial resources to identifying specific causes of these disparities and developing solutions to eliminate them. And the medical community is becoming aware that cross-cultural education -- learning how racial, ethnic, cultural and social factors influence health care -- is important for health care providers.

But you the patient can make a difference as well. Consider taking these steps to improve your health care.  

  • Educate yourself and become more "health literate." Seek information that teaches patients such things as what to expect during medical exams and visits to hospitals, how to read prescription labels, and talking to your provider.

  • When visiting your doctor, bring a family member or trusted friend with you as an advocate. This person can help you through what could be an unsettling experience and may help you communicate better with the doctor.

  • If you need translation services, let your provider know before your appointment.

  • If you have insurance, ask your insurer if services are available to help you. Many offer a variety of services, and in multiple languages, too.  

  • Make a list of questions to ask your doctor before you visit the office. Don't be afraid to ask a question, and make sure you get clear answers for all of your questions before you leave.

  • Most important, work at building a trusting relationship with your provider, and follow instructions carefully. If you're unsure about what to do, ask.

We are fortunate to live in an area that provides some of the best health care in the world. The fact that disparities in health care exist among racial and ethnic groups is unacceptable and something all of us -- hospitals, insurers, policymakers, physicians and patients alike -- should be working toward eliminating. 

Alice A. Coombs, M.D., a critical care specialist and anesthesiologist at South Shore Hospital, is chair of the Massachusetts Medical Society's Committee on Diversity in Medicine. She is a member of the Committee to End Health Care Disparities of the American Medical Association and the Commonwealth of Massachusetts' Commission to Eliminate Racial and Ethnic Disparities in Health Care. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Comments are welcome at PhysicianFocus@mms.org .

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