Racial and Ethnic Disparities in Health Care

IN RESPONSE:

Regarding Dr. Nassar's comments, the College views the elimination of disparities in health care as one of many important steps needed to decrease the number of the uninsured and increase access to good-quality health care. Lack of insurance does not exclusively affect minorities. Although minorities are at greater risk for being uninsured, white persons make up 75% of the uninsured population in the United States (1). Lack of insurance is more a reflection of socioeconomics, including the financial ability of employers to supply insurance and of employees to purchase insurance. Low-income Americans are at the highest risk for being uninsured: More than one third of the poor and more than one quarter of the near-poor lack coverage (2). The College's proposal to increase access to care therefore targets the nation's most vulnerable individuals as a first step toward providing coverage for all (3). By expanding income requirements for Medicaid and converting the State Children's Health Insurance Program (SCHIP) into a federal–state entitlement program, the plan aims to extend coverage to low-income individuals by strengthening the safety net.

In response to Dr. Cohen, the College continues to support the consideration of race and ethnicity in determining admissions to institutions of higher education. Health professions have not kept pace with the nation's changing demographics. While racial concordance between health care provider and patient is not a necessity, increased diversity in the health workforce can improve the overall health of the nation by enhancing quality and making the patient feel less isolated and more accepted by the health care system.

Affirmative action ensures that minorities are accurately represented in health professions. Eighty percent fewer minorities would have been accepted into U.S. medical schools in 1996 without affirmative action, a rate similar to that of the 1960s (4). In 2004, 1 year after the U.S. Supreme Court upheld affirmative action in university admissions, the number of black and Hispanic persons who entered medical school increased by 2.5% and almost 8%, respectively (5).

Affirmative action enhances diversity in the profession. This causes people to challenge stereotypes; shapes the quality of medical education, research, and care; and increases access to care. The College supports additional interventions throughout the educational pipeline, including strengthened math and science curricula, tutoring and mentoring programs, loan forgiveness programs, and efforts to increase faculty diversity. Overall, a health care system that mirrors the racial and ethnic makeup of the general population will be more capable of meeting the needs of individuals from diverse backgrounds.