Inequality in Health Care: Unjust, Inhumane, and Unattended!

The reputation and integrity of American medicine have been sullied. A striking 60% of Americans are unsatisfied with the health care system (1). Our system is unsafe—preventable deaths in hospitals exceed deaths attributable to such feared threats as motor vehicle accidents or AIDS (2). Physicians and medical institutions are mistrusted, with widespread concern that entanglements among physicians, health centers, and big businesses (managed care companies and the pharmaceutical industry) motivate physicians to act out of interests other than their patients' well-being (3, 4). Despite being the most expensive health care system in the world (1), the U.S. health care system fails to provide care to all our citizens and the care actually delivered is substandard (5).

Perhaps most concerning, our health care system remains largely separate and unequal (6, 7), and mounting evidence documents that health care disparities (that is, unequal medical treatment for racial and ethnic minorities not related to access to care, clinical need, patient choice, or the appropriateness of treatment) are pervasive and clinically significant (8). Evidence suggests that discrimination in the clinical encounter—defined by the Institute of Medicine as bias, prejudice, stereotyping, or miscommunication that undermines clinical decision making—remains a significant problem (8). Moreover, the organization of our health care system contributes to discriminatory care. For example, minorities, especially black patients, receive care concentrated among a relatively small group of physicians who report that they do not have access to the full range of needed clinical resources (6).

Health care disparities arise from complex interactions between patients, providers, institutions, and health systems that are difficult to unravel. Further, it is important to recognize that disparities in health found among ethnic and racial …