Access to Long-Term Care: Race as a Barrier,
19 J. Health Pol. Pol'y & L, 583 (1994).
This article addresses the problem of access to long term health care
for minority patients and how societal attitudes about race have contributed
to this disparity. By looking at studies conducted concerning the time
elapsed between when a patient is medically ready for discharge and when
he or she is actually discharged, the authors concluded that the longer
delay for minority patients is a result of the unwillingness of nursing
homes to accept minority applicants into their facilities.
The authors used data from a study of patients awaiting alternative
placement in North Carolina hospitals in 1991 which revealed a disparity
in delay for whites verses non-whites. Nonwhite patients experienced much
longer discharge delays than did non-whites regardless of a number of factors
including age, sex, conditions, or levels of special care required. [FN
1] The authors surmise that nursing home facilities prefer white patients
to patients of color.
While there does seem to be some disparity among the admission of white
patients verses minority patients to nursing home facilities, the authors
of this article should examine information other than studies conducted
in nursing homes in one state. There could other factors involved in the
hypothesis that discrimination is a direct result of discharge delays among
FN 1. Robert Broyles, David Falcolm, Access to Long Term Care: Race
As A Barrier, 19J. Health Pol. Pol'y & L, 583, 591 (1994).
"Children's Health: Racial and Ethnic Differences
in the Use of Prescription Medications", 95 Pediatrics 5 (May 1995).
The author asserts that the use of prescription drugs mirrors other
types of health care services in that minorities receive proportionately
less than do white patients. She contributes this trend to various factors
such as need, economic concerns, and structural organizations. Because
few studies have been conducted on the relationship between the use of
prescription drugs and minorities, the author examined data and statistical
data from the Household Component of the 1987 NMES and attributes disparities
to the poverty status and needs of minority children.
The author does a thorough job of examining not only data but also historical
trends of discrimination in the health care industry. The article presented
a different perspective on the effect of socioeconomic factors on the heath
of minority children.
Discrimination: The Difference With
AIDS, 6 J. Contem. Health L. & Pol'y 93 (1990).
The author begins this article by examining past discriminatory attitudes
toward minorities and how those attitudes continue in the health care industry.
According to his data, "black children have not shared equally in the overall
health gains, and their death rates are much higher than those for white
children". [FN1] Therefore, the author asserts that black children suffer
the most from racial disparities including neglect and abuse, lack of immunization,
lack of dental care, and malnutrition. Furthermore, black families are
much less likely to have adequate health insurance.
The author does a good job of addressing the impact current attitudes
toward minorities have had on the quality of health care provided for minority
children. He examines not only past practices but also current statistics
[FN1] Raymond C. O'Brien, Discrimination: The Difference with AIDS,
6 J. Contemp. Health L. & Pol'y 93, (1990).
Impact of Managed Care Organizations
on Ethnic Americans and Undeserved Populations, 5(3) Health Care for
the Poor and Undeserved, 224 (1994).
This article addresses the impact of managed care organizations on minorities
and undeserved populations and discusses how rationing has detrimentally
affected the quality of care provided for these groups.
The author first looks at the fundamental premise of managed care which
is to contain costs and then examines how the relationship between the
patient and the physician has deteriorated as a result of this. Oftentimes,
patients are unable to choose their physician and have to attend one with
which they are uncomfortable. Utilization review, according to the author,
will not abate many of the problems with the current system for various
reasons. First, minorities have many untreated illnesses which require
more intensive treatment. Due to cost containment measures they are many
times unable to obtain the care they need. Secondly, the poor are traditionally
in greater need of health care due to their living conditions. The problem
with utilization review procedures is that they fail use data from white
middle class individuals and therefore fail to properly reflect the current
access problems among minorities.
The author did a good job of examining racial trends in the current
system. Therefore, although managed care organizations appear to be a feasible
alternative to current fee for service facilities, they are inherently
discriminatory towards not only minorities but also the poor. Therefore,
although managed care appears to increase access, it essentially places
many access barriers to health care.
The Doctor Will See You Now: Medicaid
Managed Care and Indigent Children, 21 Seton Hall Legis. J. 93 (1997).
This article discusses the current problems with the Medicaid system
and how it has failed to provide adequate medical treatment for American
children, especially those in the African American Community. Foley begins
the article discussing the achievements of the Medicaid system and how
it has opened up health care services to poor children. She also acknowledges
the increased access among poor children to health care services. However,
Foley persuasively asserts that there are still many inherent problems
with the Medicaid system. She contributes this problem to many factors.
First, Foley asserts that the lack of uniformity among the states in
their implementation of the Medicaid program leads to significant disparities
in funding to individuals. Therefore, individuals who are similarly situated
are treated differently depending on the program of the their state.
Secondly, although the goal of the Medicaid program is to increase access,
many groups such as the indigent and minorities receive substandard care
and less care since there is a low participation rate among physicians
in these areas. According to Foley, this negates the overall goal of the
program since these groups are among those that they need the money the
Foley then addresses the problems faced by many children who are unable
to receive medical treatment. Her argument is based on the premise that
poor children have a tendency to contract more sicknesses because of their
inability to receive necessary medicine. Therefore, they are more likely
to suffer from chronic sicknesses and need more care. Unfortunately, many
children still do not have access to adequate health care services. This
problem is magnified for minority children who receive even less medical
care than white children.
This article clearly defines the problems faced by many poor children,
especially, minority children, who are denied access to much needed medical
services. Although the author acknowledges the accomplishments of the Medicaid
system, she addresses inherent problems that still exist in the program
and how these problems affect groups such as the poor and the minorities.
"Race, Ethnicity, & Hospital Care: The Need
for Racial and Ethnic Data", (June 1997) 30 J. Health Hospital Law, Issue
This article examines the problems of the current health system by analyzing
how race and ethnicity are major determinants of the amount and quality
of care a patient receives. The author asserts that these disparities are
a result of discrimination. Ms. Watson examines how ethnic Americans have
less access to hospitals and receive less care than do whites even when
they are admitted with the same diagnosis, source of insurance, and socioeconomic
class. Furthermore, she fears that the movement to managed care will only
augment the current difficulties since minorities, who usually need more
medical treatment than whites, will be denied various services die to efforts
to contain costs.
The author attributes these disparities to many factors. First, minorities
have difficulty receiving adequate health care since the majority of health
care facilities are located in predominantly white neighborhoods. Secondly,
many hospital procedures are directed toward white patients and therefore
indirectly impact minority patients. Third, many minorities feel uncomfortable
with seeking treatment in the current system since it is controlled primarily
by whites. Moreover, the lack of minority health care professionals only
intensifies this problem since many minorities have to attend white physicians.
According to the author, these problems of access can be abated through
increased education and awareness of racial barriers. Therefore, the author
suggests that access barriers to health care will not be rectified until
providers compile information regarding minority patients in an attempt
to identify current problems.
Noah, Barbara A. Racist Health Care,
48 Fla.L.Rev.357 (1996).
This article discusses the problems with the current medical system
and how the race of a patient may adversely impact the quality of health
care provided to him or her. Noah looks to three particular areas where
there are disparate impacts: (1) the implementation of Medicare; (2) the
selection of recipients for cadarvic organ transplants; and (3) the representation
of minorities in clinical research.
The author first addressed racial disparities in the implementation
of health care services and concluded that there were significant differences
in both rates of utilization of these services and of mortality. According
to HFCA studies, physicians have a tendency to pursue less aggressive therapies
for African American patients who did seek medical care.
Racial disparities appear also in the area of organ transplants according
to the author. African Americans have to wait longer for transplants since
UNOS relies heavily on UCL matching. Because the majority of donors are
white, their organs do not match perfectly with those of the African American
community. Noah asserts, however, that perfect matching is not necessary
and that it instead reflects indirect discrimination.
Finally, the author asserts that certain clinical practices reflect
modern attitudes toward race. For example, new research is much more easily
conducted on homogenous patients populations. However, the majority of
tests conducted are on white patients and fail to take into account characteristics
of many minorities groups.
This essay then suggests ways in which medical educators, health care
providers, and government agencies can work together to abate some of the
apparent disparities in the utilization of medical care. According to the
author, one of the best ways to reduce many of the disparities is through
awareness. Medical schools should therefore educate students as to the
severity of the problem and train them how to deal it. In addition, hospitals
could establish review boards which would monitor any racial disparities
in the administration of treatments. All these measures could be implemented
with little cost to the market.
The Impact of Managed Care on Doctors
Who Serve Poor and Minority Patients, 198 Harv. L. Rev. 1625 (May 1995).
This article addresses how the transformation of the medical industry
from fee for service to managed care provides physicians with an incentive
to serve white middle class patients as opposed to the minorities and undeserved.
The author examines the obstacles minority physicians face in the managed
care system and concludes that this will result in continued racial disparities.
Because the future of the American health market appears to lie in managed
care, doctors excluded from the managed care system may find themselves
out of the health care industry altogether. Because minority physicians
treat a higher percentage of minority patients than do white physicians,
their lack of involvement in the current system will result in continued
Toward a Healthy Future - Early and Periodic
Screening, Diagnosis, and Treatment or Poor Children, National Health
Law Program - Texas Rural Legal Aid (April 1995).
This book discusses third party coverage of preventive health services
for poor children and focuses on the need for Medicaid's Early and Periodic
Screening, Diagnosis and Treatment Program (EPSDT).
The author first addresses the need for screening. Since the number
of children living in poverty are more likely than non-poor to get sick,
they are in greater need to receive medical services. Therefore, it is
important that these children be identified so that they can be provided
the funding they need to seek care.
The author then proceeds to narrow the concerns down to children most
vulnerable: minority children, foster children, and adolescents. The number
of children from these groups living in poverty is increasing rapidly.
Most strikingly, of all the minority groups, African Americans are in the
poorest health. 46% of all African American children under the age of 18
are poor, the percentage being 40% for Latino children.
This article persuasively argues that preventive care could effectively
improve the overall quality of health among children by decreasing the
likelihood of future illnesses. The author suggests the coordination of
agencies and related programs with other state agencies and local public
Whitehall Boca v. Dept. of Health and
Rehabilitative Services, 456 So.2d 928 (1984).
This case involved a challenge to a proposed rule created by the Department
of Health and Rehabilitative Services which required applicants for certificates
of need for asylums to demonstrate that proposed services would benefit
the entire district including low income persons and traditionally neglected
groups such as minorities.
Although the case involved procedure objections to the administrative
procedures utilized by the department, the department's adoption of such
a rule demonstrates the need for expanded access to health care services
for minorities. The rules takes into account the medical needs for groups
which have traditionally been denied access to health care and requires
the department, when deciding on a application, to consider various factors
such as the extent to which the undeserved use the applicant's services.
Therefore, problems of access for the minority community continuing necessitating
the need for rules such as the one adopted by the Department of Health
and Rehabilitative Services.