What Difference Does Difference Make? The Persistence of Inequalities in Healthcare Delivery

Abstract

Scholars across many disciplines have amassed a mountain of research documenting how social differences along lines of race, class, gender, and sexuality shape how those who need medical attention are cared for in the US healthcare system. Here, we aim to succinctly review a selection of studies that have considered the many ways both patients' and healthcare providers' social identities can impact care delivery. After establishing how these differences influence patient–provider interactions and patient diagnosis, treatment, and outcomes, we argue that a critical sociological perspective can help us to better understand why these inequities persist despite decades of research calling attention to them. Specifically, we suggest that research guided by symbolic interactionist and intersectional frameworks can generate more comprehensive analyses of inequality in healthcare delivery and help researchers delve deeper into the complex interactional processes undergirding disparities in care provision. We conclude by highlighting recent work that illustrates the value of this approach.

Betweenknowinganddoingperson-centredness: A qualitative examination of health professionals’ perceptions of roles in self-management support

“…We argue that Bourdieu’s interwoven concepts of field, doxa, habitus and capital are useful in interrogating how health professional roles and identities in SMS are shaped by embedded assumptions about ‘patienthood’, ‘person-centredness’ and ‘good care’ and in turn influence how professionals construct and enact SMS (Gengler and Jarrell, 2015; Ong et al, 2014; Sointu, 2017). In this article, we draw on these interwoven concepts to investigate how health professional experience changing roles in the contemporary terrain of SMS.…”

Does the Association Between Age and Major Illness Vary by Healthcare System Quality?

“…Existing work seems to suggest that healthcare system quality upholds and promotes health across the life course by key avenues involving seeking care, quality of care, continuity of care, quality of care, and to medical treatment (e.g., Blom et al, 2016; Kunst & Machenbach, 1994; Sokka et al, 2009; Spencer & Grace, 2016). For instance, given higher healthcare system quality, individuals should be more likely to engage in preventative care, including routine primary care checkups and follow-up appointments with specialists as indicated (Bramesfeld et al, 2016; Gengler & Jarrell, 2015; Maskileyson, 2014). Additionally, medical treatment is likely to be more thorough and effective in higher quality systems, especially for highly complex or difficult-to-treat conditions like cardiovascular disease.…”

“…Despite these basic parallels, performance assessments of healthcare systems—either subjective or objective—have yet to be integrated with research into population health differences among economically advanced countries (Beckfield & Krieger, 2009; Carinci et al, 2015; Marmor & Wendt, 2012). Healthcare systems, in terms of their quality, vary robustly apart from broader economic, governmental, and social forces (Beckfield et al, 2013; Bramesfeld et al, 2016; Gengler & Jarrell, 2015; Spencer & Grace, 2016; Wendt, Frisina, & Rothgang, 2009), making them important to examine specifically as independent factors influencing healthy aging. While higher levels of economic productivity and health spending at the country level show diminishing returns for life expectancy (Organization for Economic Cooperation and Development [OECD], 2017), less clear are the ramifications of healthcare system quality for age-related health differences across countries.…”

Examining Peer-to-Peer and Patient-Provider Interactions on a Social Media Community Facilitating Ask the Doctor Services

“…Biases in Healthcare Delivery Patients with similar conditions, but differing social categorizations, often experience differences in the health care that they receive (Gengler and Jarrell 2015;Bailey et al 2017;Homan 2019). For example, women and racial minorities receive less pain relief (Pryma 2017;Meghani, Byun, and Gallagher 2012) and Hispanics and blacks are less likely to receive the most effective forms of pain relief (Meghani, Byun, and Gallagher 2012).…”