Racial disparities and site of care

Numerous studies have demonstrated that minority patients receive poorer quality health care than non-minorities. The mechanisms underlying this problem have not been identified, but the pervasiveness and consistency of racial and ethnic differences in healthcare quality have led most investigators to identify at most one or two overarching causes. To some, the consistency of these findings supports a hypothesis that physicians are at the heart of the problem. It is posited that due to sub-conscious biases, more overt prejudice, or cultural insensitivity, physicians do not treat minority patients as well as they treat non-minority patients. This hypothesis has received a great deal of attention, both in reviews from the Institute of Medicine and position statements from the American Medical Association and National Medical Association. In this paper, I review several studies that have focused on an alternative potential mechanism of racial and ethnic disparities in health care, which is based more on inequities in the structure of the healthcare system, rather than inequities in the treatment patterns of individual physicians. Determining the relative contribution of each of these mechanisms to racial and ethnic disparities in health care should be a priority.