The State of Research on Racial/Ethnic Discrimination in The Receipt of Health Care

Abstract

Objectives We conducted a review to examine current literature on the effects of interpersonal and institutional racism and discrimination occurring within health care settings on the health care received by racial/ethnic minority patients. Methods We searched the PsychNet, PubMed, and Scopus databases for articles on US populations published between January 1, 2008 and November 1, 2011. We used various combinations of the following search terms: discrimination, perceived discrimination, race, ethnicity, racism, institutional racism, stereotype, prejudice or bias, and health or health care. Fifty-eight articles were reviewed. Results Patient perception of discriminatory treatment and implicit provider biases were the most frequently examined topics in health care settings. Few studies examined the overall prevalence of racial/ethnic discrimination and none examined temporal trends. In general, measures used were insufficient for examining the impact of interpersonal discrimination or institutional racism within health care settings on racial/ethnic disparities in health care. Conclusions Better instrumentation, innovative methodology, and strategies are needed for identifying and tracking racial/ethnic discrimination in health care settings.

The effect of socioeconomic status on access to primary care: an audit study

“…8 Most previous studies of discrimination in health care have examined the effects of patient race or ethnic back ground on treatment decisions. 9,10 These studies have typically presented physicians with clinical vignettes 11,12 or used observational databases and adjusted for confounding factors. 13 Far fewer studies have focused on discrimination on the basis of patient socioeconomic status.…”

Social Determinants of Risk and Outcomes for Cardiovascular Disease

“…Numerous studies have investigated patients' perceptions of bias and discrimination while receiving health care. A review of this literature 55 found that up to 52% of blacks, 13% of Latinos, and 6% of nonHispanic whites have reported biased treatment based on their race or ethnicity. Perceptions of biased treatment in turn have been associated with reports of lower health, lower levels of self-care or adherence, interruptions in care, mistrust of clinicians, and underuse of available services, although some studies have not found these associations.…”

Capsule Commentary on Paradies et al., ‘A Systematic Review of the Extent and Measurement of Healthcare Provider Racism’

“…Not all bias is intentional, conscious or directed at the individual. 2 Discrimination research has emphasized that bias has a broader context that is not limited to interpersonal factors or encounters but also includes institutional, historic, and socially determined components with complex interplay in how individuals experience, internalize and react to bias. 3,4 As healthcare providers we want to believe that bias is not something we do and has led to the 'not-me-phenomenon,' referring to clinician beliefs that disparities do exist but not in their own clinical practices.…”

“…Unfortunately, prior research has demonstrated that physicians do have unconscious beliefs and behaviors that influence the clinical encounter through communication, evaluation and treatment decisions with lasting effects on patient morbidity and mortality. [1][2][3] In this issue of JGIM, Pardies et al present an important contribution to the discrimination research literature by focusing on provider bias. 4 The article provides a thorough review between 1995 and 2012 including international studies, thus updating and expanding prior reviews.…”

“…1,2 Cultural competence and patient-centered interviewing training have also been shown to be effective in addressing bias. 1,2,5 In summary, the elimination of healthcare disparities is a high priority and addressing all its sources, including bias, is essential to fulfilling our professional goal of providing the highest quality of healthcare for all.…”