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REPLY
Do Race and Ethnicity Play a Substantial Role in the Quality of Care That Patients Receive in the U.S. Health Care System?
Victor S. Sloan, MD
6 January 2009 | Volume 150 Issue 1 | Page 60
IN RESPONSE:
As Dr. Hegedus points out, our health care system is indeed broken. With more than 40 million U.S. residents lacking health insurance, one could hardly argue that point. However, although all U.S. residents are subject to the same broken system, several studies demonstrate that minorities have worse health outcomes. The Institute of Medicine (1) notes that in most studies, differences in care are present even after controlling for other confounding factors. There is ample evidence of racial and ethnic differences in cardiac care (2), cancer care (3), and diabetes (4). Perhaps more important, many physicians erroneously believe that race or ethnicity does not play a substantial role in the quality of care patients receive (2).
Certainly, we cannot know for certain the true feelings or biases (if any) of Amanda Gonzalez's physicians. We can only know that she, like many nonwhite patients, received substandard care. The literature provides ample evidence of prejudice in U.S. health care. The data do not support ascribing poor outcomes to a "broken system" and dismissing racial and ethnic bias as a cause of poor health outcomes.
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Author and Article Information
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From Robert Wood Johnson Medical School, New Brunswick, NJ 08901.
Potential Financial Conflicts of Interest: None disclosed.
1. Institute of Medicine. Unequal Treatment: What Healthcare Providers Need to Know About Racial and Ethnic Disparities in Healthcare. Washington, DC: National Academies Pr; 2003.
2. Lillie-Blanton M, Maddox TM, Rushing O, Mensah GA. Disparities in cardiac care: rising to the challenge of Healthy People 2010. J Am Coll Cardiol. 2004;44:503-8. [PMID: 15358011].[Abstract/Free Full Text]
3. Gross CP, Smith BD, Wolf E, Andersen M. Racial disparities in cancer therapy: did the gap narrow between 1992 and 2002? Cancer. 2008;112:900-8. [PMID: 18181101].[Medline]
4. Sequist TD, Fitzmaurice GM, Marshall R, Shaykevich S, Safran DG, Ayanian JZ. Physician performance and racial disparities in diabetes mellitus care. Arch Intern Med. 2008;168:1145-51. [PMID: 18541821].[Abstract/Free Full Text]
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