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Massachusetts Medical Society's Physician Focus

April 2014

Unequal Treatment: Disparities in Health Care


  • A 2002 Institute of Medicine report indicated that racial and ethnic minorities experience a lower quality of health care than whites.

  • Several factors cause these disparities in care, including cultural differences and poor communication between provider and patient and lack of information by patients about how to access the health system.

  • Disparities in care lead to poorer health outcomes, as minorities experience a higher incidence of complications than those who receive better care sooner.

  • Providers are urged to learn more about their patients, and patients are encouraged to be more active about their health care.

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In 2002, the Institute of Medicine released a report stating that wide differences exist between racial and ethnic minorities and non-minorities in access to health, the availability of insurance, and the quality of the health care they receive.

That report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, made public a topic that still commands the attention of the medical community a dozen years later.

That topic – health care disparities – is the subject of the April episode of Physician Focus with the Massachusetts Medical Society. Featured guests are Ronald Dunlap, M.D., 2013-2104 President of the Massachusetts Medical Society, and Milagos Abreu, M.D., M.P.H., Vice Chair of the MMS Committee on Diversity in Medicine. Hosting this edition is Alice Coombs, M.D., a past president of MMS and a member of the American Medical Association’s Commission to End Health Care Disparities.

The physicians began their discussion by pointing out the critical distinction between health disparities and health care disparities.

Health disparities are the differences in the incidence of disease between genders or given groups. Heart disease, for example, affects men and women in different ways. Similarly, African Americans are known to have higher average blood pressure than whites. These are natural occurrences.

Health care disparities represent the differences in the care that’s delivered for a certain condition. Two people, for example, with the same disease at the same level of severity, would receive different levels of care, even when insurance, income, age, and medical conditions are comparable.

The physicians were quick to note that several factors - on both the patient and provider side of the equation - contribute to health care disparities.

“A lack of knowledge, reduced communication between patients and providers, and a lack of information about how to access different services,” are some of the reasons for health care disparities, says Dr. Abreu.

Economics also plays a role, Dr. Dunlap noted. “The number of providers in a given community may be affected by the income and socio-economic status of those in the community,” he says. “Certain health care plans or medical providers may choose not to practice in that community because it’s not as profitable or because the payment systems [for providers] are so poor that it’s not viable.”

Whatever the cause, health care disparities have real impact on health outcomes. In the absence of regular care, a minority patient may present with high blood pressure, but will present later in the course of the condition. Likewise, a woman who presents with breast cancer may do so in the later stages of the disease. Both examples result in more severe complications and poorer health for the patient, as well as higher costs for treatments.

Cultural differences between the provider and patient also lead to disparities in care. “Sometimes not understanding the culture of the patient – their diet, habits, the way they live their lives – is a major issue in terms of trying to engage a patient,” says Dr. Dunlap. “The more you have in common with a patient, the more likely you are to engage them in their own healthcare.”

Both physicians agree that bridging the communication gap between provider and patient is critical to reducing disparities in care. But action on both sides of the equation is needed, they say, and both have a message for providers and patients.

Dr. Dunlap urges providers to find common ground. “In each patient,” he says, “you can find a common ground, and once you’ve found that common ground, it tends to engage the patient. And then you can draw out things from the patient, once they’re relaxed and they trust you.”

And his message for patients? “Be active. Understand your diagnoses and the things you can do to impact the outcomes, and look for providers that will work with you to achieve those outcomes.”

Dr. Abreu, likewise, prods both sides. “A priority of the practices,” she says, “should be to understand more about the culture they are serving. And patients should be more proactive about their health, to look for more information, to reach out to community organizations. They need to improve their health literacy.”

View the video above for more conversation, including discussion about the impact of demographic changes on disparities, the “unwitting and subconscious bias” of providers that impedes equal care, and how technology can help to reduce disparities in care.

MMS/Richard Gulla

Massachusetts Medical Society

Commission to End Health Care Disparities

The Latino Health Insurance Program

Massachusetts Healthy Aging Collaborative

The Commonwealth Fund

From left, Alice Coombs, M.D., Ronald Dunlap, M.D., Milagros Abreu, M.D., M.P.H.
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