Social Foundations of Health Care Inequality and Treatment Bias

Abstract

It is widely assumed that the use of medical care will lead to improvements in health, yet questions remain about the medical system's contributions to health disparities. In this review, we examine these issues with a specific focus on how health care systems may actually generate or exacerbate health disparities. We review current knowledge about inequality and bias in the health care system, including the epidemiology of such patterns and their underlying mechanisms. Over the past three decades, we observe growth in our knowledge about provider cognitive and psychological processing, including the development of precision measuring tools to analyze provider bias, racial and otherwise. In the same timeframe we observe decreased emphasis on social, interactional, organizational, and structural factors that shape variation in medical treatment. We frame our discussion within a modified social ecological model and discuss tools for moving forward and reinvigorating sociological presence in this important research area.

Earning Patient Trust: More Than a Question of Signaling

“…A starting point is to respond to the call of Black Lives Matter and recognize that the American medical system bears some culpability for the epidemic of premature black deaths. Even after controlling for access to care, according to a seminal 2003 report from the Institute of Medicine, “racial and ethnic minorities experience a lower quality of health services and are less likely to receive even routine medical procedures than white Americans.” 5 More recent surveys show that this is still the case 6 . It is no coincidence that issues of mistrust are most pronounced in end‐of‐life care.…”

“…5 More recent surveys show that this is still the case. 6 It is no coincidence that issues of mistrust are most pronounced in end-oflife care. Crawley has published a rich body of work in this area, rooted in her ethnographic study of the medical decision-making processes of African American adults diagnosed with potentially fatal illnesses.…”

What is the future of research on medical decision making? (And is it bright?): A response to Drewniak and colleagues

“…of inequality in medical practice, extant literature has identified no fewer than three generations of patterns in non-medical influences on diagnostic and treatment decisions, at the levels of patient characteristics, provider attributes, and country/system differences (Spencer and Grace 2016). Depending on the disciplinary approach, these pieces are published in a wide range of journals and also under a range of key words, including "medical care," "medical treatment," "medical decision making," "physician bias," and, especially prominent in medical outlets, "medical practice variation."…”

What does physicians' clinical expertise contribute to oncologic decision‐making? A qualitative interview study

“…3,4 The methodology of the "external evidence" has been the main focus of EBM during the past 2 decades; however, the character of the "internal evidence" and its integration with trial data has been much less addressed in research, even if EBM proponents stress that in clinical practice knowledge of best evidence must be combined with a respective attitude and motivation. 5 Whereas clinical experience is supposed to play an inevitable role for individualized care, it may also account for treatment biases and health care inequalities, 6 which hinder the implementation of research findings. Regarding potential biases, research, for example, suggests that physicians develop different cognitive styles, indicating that physicians who are depending more on their rational thinking instead of intuitive responses are less prone to making mistakes during the decision process.…”