Racial disparities in care: the concealed legacy of a divided system

New national initiatives to end racial disparities in health could benefit from the experience with Title VI enforcement in the Medicare Program.

The goals of this study were to describe events in a test case to extend Medicare Title VI conditions for hospitals to the practice patterns of its medical staff and how the outcome shaped disparities.

This article distills interviews, archives, and secondary data sources.

This study is an historical narrative.

The test case was a costly failure. Although the Title VI effort eliminated segregation on hospital floors and equalized overall use, physician practice patterns were left unexamined, contributing to the persistence of disparities in treatment.

If current efforts are to be successful, they will need to 1) address the structural issues that shape disparities, 2) pay particular attention to reengineering care in ways that overcome historic patterns, and 3) ensure a greater degree of accountability.