Advertisement

U.S. Healthcare 101: What Everyone Ought to Know about How U.S. Inhabitants are Treated (or Not)

  • Aana Marie Vigen
Part of the Black Religion / Womanist Thought / Social Justice book series (BRWT)

Abstract

Let’s be frank: News stories about healthcare can be tedious. This may sound like a strange statement to make near the beginning of a book dedicated to exploring healthcare quality disparities. Yet it is the truth. The endless parade of numbers, factoids, and opinions—the mind-boggling figures spent on U.S. healthcare, the continual debates about prescription drugs, accusations and denials of medical malpractice, dizzying proposals about how to reform Medicare or Medicaid, the rapidly rising numbers of uninsured persons—can dull a person’s interest rather quickly. And it is all too easy to skip to the next story, change channels, or surf a more scintillating website.

Keywords

Census Bureau Bush Administration Healthcare Disparity Affluent Patient Insurance Crisis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Notes

  1. 1.
    Carmen DeNavas-Walt, Bernadette D. Proctor, and Cheryl Hill Lee, U.S. Census Bureau, Current Population Reports, P60–229, Income, Poverty, and Health Insurance Coverage in the United States: 2004 (Washington, DC: U.S. Government Printing Office, 2005), 16, online: 2005pubs/p60–229.pdf. (Citation abbreviated hereafter as DeNavas-Walt et al., Income, Poverty, and Health Insurance Coverage in the United States: 2004.)Google Scholar
  2. 2.
    In 2002, whereas 15.2 percent of the general U.S. population was uninsured for the entire year, 30.4 percent of all people living in poverty were uninsured. See Robert J. Mills and Shailesh Bhandari, U.S. Census Bureau, Current Population Reports, P60–223, Health Insurance Coverage in the United States: 2002 (Washington, DC: U.S. Government Printing Office, 2003), 6, online: www.census.gov/prod/2003pubs/p60–223.pdf.Google Scholar
  3. 36.
    See R.S. Morrison et al., “‘We Don’t Carry That’—Failure of Pharmacies in Predominantly Nonwhite Neighborhoods to Stock Opioid Analgesic,” The New England Journal of Medicine 342, no. 14(2000):1023–1026.CrossRefGoogle Scholar
  4. 37.
    Robert Moses was responsible for the monumental transportation and infrastructure projects throughout New York City in the mid-twentieth century. In particular, he orchestrated the construction of the Cross Bronx Expressway and determined where it would go such that it cut off the South Bronx from the rest of the Bronx. Furthermore, this roadway went over the South Bronx instead of through it, which meant that it did not serve any of the inhabitants of this neighborhood. The Reverend Heidi Neumark discusses some of the implications of Moses’ work. See Heidi B. Neumark, Breathing Space: A Spiritual Journey in the South Bronx (Boston: Beacon, 2003).Google Scholar
  5. 57.
    Here is a sampling of research that are among those cited by the IOM bibliography: J.Z. Ayanian et al., “Racial Differences in the Use of Revascularization Procedures after Coronary Angiography,” Journal of the American Medical Association 284(2000):1670–1676;CrossRefGoogle Scholar
  6. L.C. Einbinder and K.A. Schulman, “The Effect of Race on the Referral process for Invasive Cardiac Procedures,” Medical Care Research and Review 57, supplement 1(2000):162–180;CrossRefGoogle Scholar
  7. J. Etchason et al., “Racial and Ethnic Disparities in Health Care,” Journal of the American Medical Association 285(2001):883;CrossRefGoogle Scholar
  8. K. Fiscella et al., “Inequality in Quality: Addressing Socioeconomic, Racial, and Ethnic Disparities in Health Care,” Journal of the American Medical Association 284(2000): 2579–2584;CrossRefGoogle Scholar
  9. R.M. Mayberry et al., “Racial and Ethnic Differences in Access to Medical Care,” Medical Care Research and Review 57, supplement 1(2000):108–145;CrossRefGoogle Scholar
  10. S.L. Furth et al., “Racial Differences in Access to the Kidney Transplant Waiting List for Children and Adolescents with End-Stage Renal Disease,” Pediatrics 106(2000): 756–761;CrossRefGoogle Scholar
  11. M.P. DelBello et al., “Effects of Race on Psychiatric Diagnosis of Hospitalized Adolescents: A Retrospective Chart Review,” Journal of Child Adolescent Psychopharmacology 11(2001):95–103;CrossRefGoogle Scholar
  12. A.L. Whaley, “Racism in the Provision of Mental Health Services: A Social-Cognitive Analysis,” American Journal of Orthopsychiatry 68(1998):47–57;CrossRefGoogle Scholar
  13. K.L. Kahn et al., “Healthcare for Black and Poor Hospitalized Medicare Patients,” Journal of the American Medical Association 271(1994):1169–1174;CrossRefGoogle Scholar
  14. J.Z. Ayanian et al., “Quality of Care by Race and Gender for Congestive Heart Failure and Pneumonia,” Medical Care 37(1999):1260–1269. See ibid.CrossRefGoogle Scholar
  15. 58.
    Eric C. Schneider, Alan M. Zaslavsky, and Arnold M. Epstein, “Racial Disparities in the Quality of Care for Enrollees in Medicare Managed Care,” Journal of the American Medical Association 287, no. 10(2002):1290. They gathered this data by analyzing the 1998 Health Plan Employer Data and Information Set (HEDIS) which annually tracks these four quality of care measures. (Citation abbreviated hereafter as Schneider et al., “Racial Disparities in the Quality of Care for Enrollees in Medicare Managed Care.”)Google Scholar
  16. 60.
    See Anne Fadiman, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures (New York: Farrar, Straus, and Giroux, 1997).Google Scholar
  17. 63.
    See, e.g., S.C. Collins et al., U.S. Minority Health: A Chartbook (New York: Commonwealth Fund, 1999).Google Scholar
  18. 66.
    J. Emilio Carrillo, Fernando M. Treviño, Joseph R. Betancourt, and Alberto Coustasse, “Latino Access to Health Care: The Role of Insurance, Managed Care, and Institutional Barriers,” in Health Issues in the Latino Community, ed. Marilyn Aguirre-Molina, Carlos W. Molina, and Ruth Enid Zambrana (San Francisco: Jossey-Bass, 2001), 67. (Citation abbreviated hereafter as Carrillo et al., “Latino Access to Health Care.”)Google Scholar
  19. 67.
    R.A. David and M. Rhee, “The Impact of Language as a Barrier to Effective Health Care in an Underserved Urban Latino Community,” Mount Sinai Journal of Medicine 65, nos. 5–6(October/November 1998):393–397. (Citation is abbreviated hereafter as David and Rhee, “The Impact of Language as a Barrier to Effective Health Care in an Underserved Urban Latino Community.”)Google Scholar
  20. 68.
    See E.A. Jacobs et al., “Impact of Interpreter Services on Delivery of Health Care to Limited-English-Proficient Patients,” Journal of General Internal Medicine 16(2001):468–474;CrossRefGoogle Scholar
  21. K.P. Derose and D.W. Baker, “Limited English Proficiency and Latinos’ Use of Physician Services,” Medical Care Research and Review 57(2000):76–91.CrossRefGoogle Scholar
  22. 69.
    Kevin Fiscella et al., “Disparities in Health Care by Race, Ethnicity, and Language Among the Insured: Finding from a National Samplem,” Medical Care 40, no.1(2002):52–59. The researchers gathered a national sample through the use of a telephone survey tool.CrossRefGoogle Scholar
  23. 71.
    D.W. Baker, C.D. Stevens, and R.H. Brook, “Determinants of Emergency Department Use: Are Race and Ethnicity Important?” Annals of Emergency Medicine 28, no.6(1996):677–682, cited in Smedley et al., Unequal Treatment, 142.CrossRefGoogle Scholar
  24. 73.
    Two studies raise this point: David and Rhee, “The Impact of Language as a Barrier to Effective Health Care in an Underserved Urban Latino Community,” 393–397; L.S. Morales et al., “Are Latinos Less Satisfied with Communication by Health Care Providers?” Journal of General Internal Medicine 14(1999):409–411. Both cited in Carrillo et al., “Latino Access to Health Care,” 68.CrossRefGoogle Scholar
  25. 74.
    P. Ebden, O.J. Carey, A. Bhatt, and B. Harrison, “The Bilingual Consultation,” Lancet 1, no. 8581(1988):347, cited in Smedley et al., Unequal Treatment, 143.CrossRefGoogle Scholar
  26. 75.
    Cross-cultural nursing curricula often make this point. See, e.g., Larry D. Purnell and Betty J. Paulanka, Transultural Health Care: A Culturally Competent Approach, 2nd ed. (Philadelphia: F.A. Davis Co., 2003). (Citation abbreviated hereafter as Purnell and Paulanka, Transultural Health Care);Google Scholar
  27. Bette Bonder, Laura Martin, and Andy Miracle, Culture in Clinical Care (New Jersey: Slack Inc., 2002). (Citation abbreviated hereafter as Bonder et al., Culture in Clinical Care.)Google Scholar
  28. 76.
    J. Cho and B.M. Solis, Healthy Families Culture and Linguistics Resources Survey: A Physician Perspective on their Diverse Member Population (Los Angeles: LA Care Health Plan, 2001), cited in Smedley et al., Unequal Treatment, 90.Google Scholar
  29. 78.
    S. Woloshin, N.A. Bickell, L.M. Schwartz, T. Gany, and H.G. Welch, “Language Barriers in Medicine in the United States,” Journal of the American Medical Association 273, no. 9(1995):724–728, cited in Smedley et al., Unequal Treatment, 141.CrossRefGoogle Scholar
  30. 79.
    Certainly the experience of not getting all the information one would like from a physician is not unique to patients who do not speak English well. For example, in one study of Black and white patients who had had cardiac stress testing that yielded positive results, the researchers found that both Black and white patients expressed that the information they had received from their doctors was “incomplete, vague, ambiguous, and unclear.” Both groups of patients also reported that they needed further convincing “of the need for additional, invasive tests and procedures.” Interestingly, however, the Black patients in particular consistently emphasized “a preference for building a relationship with physicians (meaning trust) before agreeing to an invasive cardiac procedure and just as consistently complained that such trust was lacking.” Both white and Black patients agreed that they wanted more and clearer information from their doctors. Yet it is important to note that the Black patients were the ones in particular to express how important trust was as a precondition for further treatments and that this trust was lacking. See Tracie C. Collins et al., “Racial Differences in How Patients Perceive Physician Communication Regarding Cardiac Testing,” Medical Care 40, no.1(January Supplement 2002):I-27–I-34.Google Scholar
  31. 81.
    Carrillo et al., “Latino Access to Health Care,” 66. See also ibid., 114; Associated Press, “Report Urges Diversity in Health Jobs,” February 5, 2004. They cite from the 2004 Institute of Medicine Report, Brian Smedley, Adrienne Stith, and Lonnie R. Bristow, eds., In the Nation’s Compelling Interest: Ensuring Diversity in the Health Care Workforce (Washington, DC: National Academies Press, 2004), online: www.iom.edu.Google Scholar
  32. 83.
    See V.L. Bonham, “Race, Ethnicity, and Pain Treatment: Striving to Understand the Causes and Solutions to the Disparities in Pain Treatment,” Journal of Law Medicine, and Ethics 29(2001):52–68, cited in Smedley et al., Unequal Treatment, 168.CrossRefGoogle Scholar
  33. 84.
    Michelle van Ryn and Jane Burke, “The Effect of Patient Race and Socio-Economic Status on Physicians’ Perceptions of Patients,” Social Science and Medicine 50(2000):814. (Citation abbreviated hereafter as Van Ryn and Burke, “The Effect of Patient Race and Socio-Economic Status on Physicians’ Perceptions of Patients.”) Reprinted from Michelle van Ryn and Jane Burke, “The Effect of Patient Race and Socio-Economic Status on Physicians’ Perceptions of Patients,” Social Science and Medicine 50(2000):814. Copyright © (2000) with permission from Elsevier. Google Scholar
  34. 88.
    A.I. Balsa and T.G. McGuire, “Prejudice, Clinical Uncertainty and Stereotyping as Sources of Health Disparities,” Journal of Health Economics 22, no. 1(2003):89–116. (Citation abbreviated hereafter as Balsa and McGuire, “Prejudice, Clinical Uncertainty and Stereotyping as Sources of Health Disparities.”)CrossRefGoogle Scholar
  35. 100.
    Saif Rathore et al., “The Effects of Patient Sex and Race on Medical Students’ Ratings of Quality of Life,” American Journal of Medicine 108(2000):561–566. Reprinted from American Journal of Medicine 108(1), Rahore et al., “The Effects of Patient Sex and Race on Medical Students’ Ratings of Quality of Life,” 561–566. Copyright© 2000, with permission from Excerpta Medica, Inc. All of the student participants had already received adequate theoretical instruction to identify angina and to understand its relationship to coronary artery disease. However, they were recruited specifically because they had not yet had much clinical experience and would thus “have limited knowledge of the incidence of coronary artery disease by race and sex.” Ibid., 561–562.CrossRefGoogle Scholar
  36. 105.
    Michelle van Ryn, “Research on the Provider Contribution to Race/Ethnicity Disparities in Medical Care,” Medical Care 40, no. 1(2002): I-140–I-151. (Citation abbreviated hereafter as Van Ryn, “Research on the Provider Contribution to Race/Ethnicity Disparities in Medical Care.”)Google Scholar
  37. 109.
    For example, in their bibliography, the IOM cites the following: J.F. Dovidio, “Stereotyping,” in R.A. Wilson and EC. Keil, eds., The MIT Encyclopedia of the Cognitive Sciences (Cambridge: MIT Press, 1999);Google Scholar
  38. J.F. Dovidio et al., “Stereotyping, Prejudice, and Discrimination: Another Look,” in N. Macrae, C. Stangor, and M. Hewstone, eds., Stereotypes and Stereotyping (New York: Guilford, 1996), 276–319;Google Scholar
  39. J.F. Dovidio and S.L. Gaertner, “On the Nature of Contemporary Prejudice: The Causes, Consequences, and Challenges of Aversive Racism,” in J.L. Eberhardt and S.T. Fiske, eds., Confronting Racism: The Problem and the Response (Thousand Oaks: Sage, 1998), 3–32;Google Scholar
  40. and J.F. Dovidio et al., “Implicit and Explicit Prejudice and Interracial Interaction,” Journal of Personality & Social Psychology 82, no. 1 (2002):62–68;CrossRefGoogle Scholar
  41. S.T Fiske, “Stereotyping, Prejudice, and Discrimination,” in D.T. Gilbert et al., eds., The Handbook of Social Psychology, 4th ed., 2 vols. (New York: McGraw-Hill, 1998), vol. 2, 357–411. See Smedley et al., Unequal Treatment. Google Scholar
  42. 111.
    Social cognition literature is helpful in understanding the functioning of stereotypes. See, e.g., these sources cited in Van Ryn, “Research on the Provider Contribution to Race/Ethnicity Disparities in Medical Care,” 1–147–151; C.N. Macrae and G.V. Bodenhausen, “Social Cognition: Categorical Person Perception,” British Journal of Social Psychology 92(2001):239–255;CrossRefGoogle Scholar
  43. Z. Kunda, Social Cognition: Making Sense of People (Cambridge: MIT Press, 1999);Google Scholar
  44. C.N. Macrae et al., “Stereotypes as Energy-Saving Devices: A Peek Inside the Cognitive Toolbox,” Journal of Pers Soc Psychol 66(1994):33–47;CrossRefGoogle Scholar
  45. C. Stangor, ed., Stereotypes and Prejudice (Philadelphia: Psychology Press, 2001).Google Scholar
  46. 118.
    Donald L. Barlett and James B. Steele, Critical Condition: How Health Care in America Became Big Business and Bad Medicine (New York: Doubleday, 2004), 13. (Citation abbreviated hereafter as Barlett and Steele, Critical Condition.)Google Scholar
  47. 121.
    Carrillo et al., “Latino Access to Health Care,” 55. As evidence for this claim, the authors cite G. F. Anderson, Multinational Comparisons of Health Care: Expenditures, Coverage and Outcomes (New York: Commonwealth Fund, 1998);Google Scholar
  48. and S. Woolhandler and D.U. Himmelstein, “The Deteriorating Administrative Efficiency of the U.S. Health Care System,” New England Journal of Medicine 324, no.18(1991):1253–1258.CrossRefGoogle Scholar
  49. 131.
    J.L. Hargraves, J.J. Stoddard, and S. Trude, “Minority Physicians’ Experiences Obtaining Referrals to Specialists and Hospital Admissions,” Medscape General Medicine 3, no. 4(2001):10, cited in Smedley et al., Unequal Treatment, 146.Google Scholar
  50. 142.
    See J.J. Escarse et al., “Health Care Reform and Minorities: Why Universal Insurance Won’t Equalize Access,” Leonard Davis Institute Health Policy Research Quality Review 3(1993): 1–2.Google Scholar
  51. 144.
    “If anything distinguished the health field, it is the abundance of carefully crafted technical reports, studies, and policy recommendations. The last fifteen to twenty years have seen a constant stream of special national initiatives, reports, summits, and task forces to address the health needs of Latinos. Yet the goal of many of these endeavors have yet to be fully actualized.” Marilyn Aguirre-Molina, Angelo Falcón, and Carlos W. Molina, “Latino Health Policy: A Look to the Future,” in Health Issues in the Latino Community, ed. Marilyn Aguirre-Molina, Carlos W. Molina, and Ruth Enid Zambrana (San Francisco: Jossey-Bass, 2001), 461. (Citation abbreviated hereafter as Aguirre-Molina et al., “Latino Health Policy: A Look to the Future.”)Google Scholar

Copyright information

© Aana Marie Vigen 2006

Authors and Affiliations

  • Aana Marie Vigen

There are no affiliations available

Personalised recommendations