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Access to Health Care and Minorities
Annotated Bibliography

Andrew J. Schweller 
Copyright @ 1997 Andrew J. Schweller . All Rights Reserved.

Spring Semester 1997


This annotated bibliography centers around Ethnic Americans' access to health care. I chose this topic because I wanted to learn more about the subject and for the basic fact that access to health care seemed to be a major issue in many of the discussions we had in class. America's health care program has a serious problem when it comes to addressing the needs of Ethnic Minorities. The system is woefully inadequate in allowing Ethnic Americans access to health care. Several proposals have been submitted concerning a reform of the current system. People have propose amending Title VI, granting individuals universal insurance, training more Ethnic Americans to enter the health care field, encouraging cities to build facilities near the poor and educating Ethnic Americans about preventative health care.

What this nation must realize is that no single idea will solve the problem. There is no simple solution to the problem. Multiple steps need to be taken to reform this country's health care system. It is time for the people to say they have had enough and realize that the current system is inefficient and fails to provide quality care to all persons who live within its borders. Providing quality care for a reasonable price is not an insurmountable goal. Many Western nations are able to define health care as being for the public good and are able to provide good quality health care to their populations at an affordable cost.

The United States continues to be one of the only industrialized nations besides South Africa continues to see health care as a privilege for its populations. This view impairs many from seeking health care and leads to the nation having to spend more money to treat illnesses in a latter stage. Besides the monetary aspect of the problem, many are unable to increase their standard of living because of their poor health. Finally, many good people are forced to an early grave because of this lack of health care. We cannot put a value on the loss of a father or mother in these cases. One day we will wake up and find that the United States of America is the only industrialize country to view health care as a privilege and maybe then, we will reform our views on access to health care.


Americans Report on Their Access to Health Care

Disparate Impact Under Title VI: Discrimination, by Any Other Name, Will Still Have the Same Impact

Does Clinton's Health Care Reform Proposal Insure [E]Qual[ity] Of Health Care for the Ethnic Americans and the Poor?

Health Care in the Inner City: Asking the Right Question

How White and African Americans View Their Health and Social Problems; Different Experiences, Different Expectations

Impact of Managed Care Organizations on Ethnic Americans and Underserved Populations

Is Health Care Racist?

Medical Apartheid: An American Perspective

Physician Race and Care of Minority and Medically Indigent Patients

Racist Health Care: Reforming an Unjust Health Care System to Meet The Needs of African-Americans

Reinvigorating Title VI: Defending Health Care Discrimination--It Shouldn't Be So Easy

Securing Health or Just Health Care? The Effect of the Health Care System on The Health of America

The Impact of Managed Care on Doctors who Serve Poor and Minority Patients

The Role of Civil Rights Litigation and the Relationship Between Burdens of Proof and the Experience of Denial

Title VI Challenges by Private Parties to the Location of Health Care Facilities: Toward a Just and Effective Action



Daniel K. Hampton, Title Vi Challenges By Private Parties To The Location Of Health Care Facilities: Toward A Just And Effective Action, 37 B.C.L.Rev. 517 (1996)

This article explores the legal issues surrounding judicial enforcement of civil rights actions by private parties concerning the location of health care facilities. The article discusses the background of Title VI of the Civil Rights Act and how it allows for regulations to be pronounced by the Department of Health and Human Services. These regulations allow private parties to bring causes of action based on disparate impact. Under these regulations, no proof of discriminatory intent is necessary to establish a violation of Title VI. (E.N.(1)

) The Article examines a number of health care facility cases, the use of Title VI over a period of time and the burdens on the parties to a Title VI action. The author is critical of ease a defendant has in proving there is no disparate impact on ethnic Americans. A defendant is allowed to defend an act on the basis that it is required by necessity. The author points out that this means that there is a manifest relationship to the defendant's health care objectives. After the defendant meets this burden, the plaintiff is required to show that a less discriminatory option is available that is comparably effective.

The author calls for lowering the burden of plaintiffs in Title VI actions. Specifically, the author demands a "Continuing Violation Doctrine" which would allow plaintiffs more time to bring Title VI actions. A plaintiff would be required to show that out of a series of related acts, one act was committed within the statute of limitations. The author also discusses allowing a plaintiff to show that more reasonable but less discriminatory options are available and making the defendant show that these options are not less discriminatory or substantially less cost effective in accomplishing its goals.

Many of the articles that I have read regarding the use of Title VI propose increasing the burden the defendant. It does seem very easy for a defendant to show that there is no disparate impact. The standard proposed by Hampton still puts a lot pressure on the plaintiff which I believe must still be imposed. After all, the plaintiff is the one bringing suit a bears the burden of proof and persuasion in any trial. The defendant should have some burden besides the showing of a generalized excuse. We are dealing with an industry that will effect the lives of many people and we should not allow courts to just rubber stamp a general justification given by the defendant. [Back]


Amy Jurevic, Disparate Impact Under Title VI: Discrimination, By Any Other Name, Will Still Have The Same Impact, 15 St. Louis U. Pub. L. Rev. 237 (1996).

The article is concerned with the state of Oregon's Health Plan. The goal of the plan is to try to balance the allocated resources between health care and the areas that affect health care. ((2)

) Under the plan, several treatments are not covered. The author notes that one such treatment that is not covered is obesity which affects more African American women than white women. ((3)

This represents a disparate impact on African-Americans. This article examines whether Title VI prohibits the plan to not cover obesity.

The first part of the article provides a good discussion about the background and purpose of Title VI. The author notes that although Title VI has tamed blatant discrimination it allows disparate impact discrimination. In section II, the author describes the evolution of Title VI in the courts. Here the author points out that the courts have found Title VI does not prohibit a policy or practice that only has a disparate impact. "Courts will look at whether an agency regulation prohibits practices that disparately impacts individuals due to race, color or national origin." (4)

Thus, in order to have a prima facia cases under Title VI, a plaintiff must allege disparate impact, a plaintiff must cite specific agency regulations that prohibit discriminatory impact against recipients of federal funds. (5)

The author then examines the four theories that various lower courts use to see if the defendant has met its burden. The final two sections of the article describes the Oregon Health Plan and application of Title VI. The author lays out a prima facia case of disparate impact. She then analyzes the defendant's case using the four approaches justifying the disparate impact.

This article shows that although the Supreme Court has laid down concrete rules concerning what the plaintiff must show to have a prima facia case, it has not given the lower courts much guidance in evaluating what a defendant can use as an acceptable justification. We therefore have four approaches and no agreement. [Back]


Barbara A. Bartman & Ernest Moy, Physician Race and Care of Minority and Medically Indigent Patients, 273 JAMA (1995).

This article examines whether nonwhite physicians provide care to different patient populations than white physicians. The study for which the article is based upon, used a nationally representative survey of patients. The study found that patient race and ethnicity were associated with physician race. Minority patients were four times more likely to receive care from nonwhite physicians than were non-Hispanic white patients. Medically indigent patients were also more likely to receive care from nonwhite physicians. The report indicated that since nonwhite physicians provided a disproportionate amount of care to the indigent, these same doctors bear the heavy financial burden associated with caring for such patients. This leads to a higher level of dissatisfaction among nonwhite physicians than white physicians.

This article lends some credit to the idea mentioned in a prior article that medical schools should recruit more minority students as a step to solve the accessibility problem. This article does not examine the reasons why nonwhite doctors see more numbers of minority patients which I believe should be studied. This may indicate that white doctors are making some error in treating nonwhite patients which makes them not want to see a white doctor. [Back]


Robert J, Blendon, Et. Als., How White and African Americans View Their Health and Social Problems; Different Experiences, Different Expectations, JAMA Vol.273, No. 4 page 341 (1995).

A number of studies indicate there are substantial differences in the ways that African-Americans an white Americans view access to health services and the quality of care they receive. The authors obtained their data from a national household survey conducted by the Harvard School of Public Health and the National Opinion Research Center. African-Americans were more likely than whites to rate the health services in their communities as fair or poor. Black Americans were also more likely to respond that the nation's health care system needed to be overhauled. Several reasons were given for these responses; income, cultural effects and education. Data obtained suggested that more African Americans than white Americans encountered financial difficulty when it came to obtaining health care. Part of this problem was that many African-Americans did not have any form of health insurance. The study indicated that the problem of poverty was closely related to lack of education. African-Americans were less likely to have attended college than whites. Furthermore, one in seven African-Americans reported having a problem seeking education while the number of whites expressing this concern was one in eleven.

This article gave several figures showing that a number of African-Americans are dissatisfied with the American health system. The numbers show that there are large numbers of African-Americans receive a small amount of aid from the government. Based on the article, we have a serious problem in addressing the health care needs of African-Americans. It seems to show that whites are receiving the care they need while African-Americans are not. This data hints that discrimination is being actively practiced by the federal government and society. There should not be a significant difference in the way both groups view health care. [Back]


Note, The Impact of Managed Care on Doctors Who Serve Poor and Minority Patients, 108 Harvard L. Rev. 1625 (May 1995).

This article focuses on the possible impacts that managed care could have on minorities both patients and doctors in the years to come. The growth in the area of managed care could lead minorities to not be able to receive treatment from doctors participating in managed care. There are several reasons for this conclusion. Since managed care seeks to keep costs low, many providers may not want doctors who treat substantial numbers of poor patients within their group. Because of the environment they live in and their financial situation, the poor are more likely to get sick and require costly treatment. Minority doctors treat many of these people. An HMO may seek to exclude these doctors because it does not want doctors on board that have to spend more money on patients.

In order to join an HMO and earn a living, many minority doctors will have to quit seeing poor minority patients. This will leave many poor minorities without a physician and shall no doubt lead to a decrease in the access and quality of care. Since minority's access will be limited, many poor people will seek treatment only when they become critically ill and require expensive treatment. If a doctor does not join the HMO, other segments of our population shall be hurt, because many good doctors are minorities.

To combat this situation, the note proposes that Congress could take a number of actions. One of which is to expand the scope of Title VII to cover all quasi-employment relationships between HMOs and the providers with whom they contract. Another proposal is to draft regulatory statutes that would prevent HMO's from discriminating on the basis of race. A third proposal is that managed care providers must hire a certain number of doctors from the inner city and take on a number of poor patients. Finally, a statute should be drafted that puts a high burden on the defendant to prove that in any disparate impact claim, the HMO had a legitimate and substantial non-discriminatory reason for what it did and there were no non-discriminatory options available.

I believe that the note is correct in raising the standard an HMO must prove in cases involving disparate impact. It just seems too easy for defendants to find a legitimate business reason for its action. Furthermore, I think it would be a good idea to mandate that HMO's had to treat a certain number of poor patients, After all, if they are not treated, it will lead to increase costs in the future and some entity will have to pay for more expensive treatment. The entity will then pass this someone who can pay. [Back]


Marianne L. Engleman Lado, The Role of Civil Rights Litigation and the Relationship Between Burdens of Proof and The Experience of Denial, 60 Brook. L. Rev 239 (1994).

This article examines barriers to access to care for African-Americans and the role and impact of civil rights litigators on racial discrimination in the delivery of health care. Health care providers utilize several practices to insure that racial segregation still exists. Some physicians limit their services to privately insured patients. Private hospitals and nursing homes often assign low-income African-Americans to separate wings where they receive inferior care. Hospitals and other health care facilities have relocated from the inner city, closed departments which are often used by the poor, or privatized in order to restrict the numbers of poor African-Americans it treats. Several African Americans tell their story of the hardship they face in receiving health care and a lower level of care than white patients. The article states that many of these practices are illegal and can be remedied through the use of civil rights statutes. The unfortunate fact is that these statutes are not being enforced by the federal government and the states. The article points out that many of these statutes allow private plaintiffs to bring actions to challenge barriers to access.

The problem the article brings up is that although the statutes allow plaintiffs to bring suit, in the courtroom, the judiciary applies a higher burden of proof than the statutes require. "Plaintiffs are required not to show adverse impact or that the defendant burdens an activity, but that the plaintiff was foreclosed or barred from access." (6)

The use of this standard makes it extremely difficult for plaintiffs to win on claims of structural forms of discrimination.

I find the article to represent a scary picture of the plight of the poor in securing access to care. It appears that we have these laws, but many will not enforce them, not even judges. It appears that the poor are not an important segment of the population and the status quo should be continued. It appears that we are using a survival of the fittest model to explain our acts. The problem with using this model is that we are dealing with people, not animals, unless we want to call those who are not poor animals. [Back]


Lawrence O. Gostin, Securing Health Or Just Health Care? The Effect Of the Health Care System On The Health Of America, 39 St. Louis U. L.J. 7 (1994).

The author structures his article around the thesis that the most important objective of health care reform should be the promotion of health. In order to promote health, the government should provide reasonable levels of resources in order to guarantee all citizens universal coverage. The author breaks down his thesis into four arguments. The first is that health is valuable to society. The next argument is that universal health care is important in achieving a healthy population. The third argument made by the author is that although universal health care will help people to be healthy, equitable access should be guaranteed to all of the nation's classes. Finally, the author points out the problems with the private health care market.

The author is adamant that the government should not be solely or even predominantly responsible for the health of individuals, but it should make sure people should not live in unhealthy environments and provide prevention services. The author stresses that the government should provide prevention services because they are more cost efficient and they save money in other areas by making people more productive. The preventative services should be accessible to all if they are to help all citizens. Not only should financial barriers be broken, but any form of access should break down structural, personal and cultural barriers. Any reform should take into account that many ethnic populations lack care and are typically sicker than white populations. As a result, many people within these ethnic populations are denied the chance to move up in society. Finally, the author points out that many of the health problems ethnic-Americans suffer is because of the market theory health care system allowed in the United States. Insurance companies exclude the poor because they are a bad risk. ERISA allows employers to engage in exclusionary practices.

I liked this article. It represents a common sense approach to health care. The government should try to allocate resources towards preventing illnesses rather than waiting till costly treatment is needed and the disease or illness is in a more advanced form. Everyone should be given an equal amount of health care and start on the same level. If someone wants increased insurance to cover open-heart surgery fine, but the fact is, if we can prevent the person from ever needing open-heart surgery the population will be healthier and the costs associated with health care will not be as high. It seems that as a collective group, we can obtain better health care than we can as individuals. Finally, insuring that all citizens have access to quality preventative services allows our society to be more productive and allow people to have the same kinds of chances. [Back]


Vernellia R. Randall, Impact Of Managed Care Organizations On Ethnic Americans And Underserved Populations, 5 J. of Health Care for the Poor and Underserved 224 (1994).

Due to the rising costs associated with health care, employers, government and other third party payers have started to cut back on what they spend. Many insurance plans have adopted utilization review which has an adverse impact on "Ethnic-Americans". This is because many of the standards and decisions are based on data based on "European Americans". Because of utilization review, many Ethnic Americans do not have access to health care due to the fact that under the standards Ethnic Americans are sicker than European Americans. Since they are sicker, Ethnic-Americans cost more to treat. This is a definite drawback to the managed care organization since it wants to save money. The utilization system also makes Ethnic-Americans choose not to receive care. Under a prospective system, an Ethnic-American knows ahead of time that care will not be covered. Therefore, the patient will opt not to choose the care. The article also discusses the ways in which third party payers encourage providers to underutilized treatment given to patients in order to save money. Several mechanisms are discussed such as capitation, discounted fee for service, per diem payments and surplus sharing. These mechanisms put pressure on the provider to be frugal in giving treatment. Under these plans, even if an Ethnic-American can obtain treatment, they may not receive the highest quality treatment available.

Managed health care is out of control. Something must be done about the way many of these organizations are trying to cut corners. I understand that we want health care to be affordable and available to all, but we also want it to be to be of good quality. The only problem I had with this article was that it failed to offer an alternative. I am well aware of the problems that accompany Ethnic-Americans ability to see a managed care provider, but there has got to be other ways that we can encourage doctors to save money rather than encouraging them underutilized treatment. [Back]


Vernellia R. Randall, Does Clinton's Health Care Reform Proposal Insure [E]Qual[ity] Of Health Care For The Ethnic Americans and the Poor? 60 Brook.L.Rev. 167 (1994).

This article analyzes the potential for health care reform in its current form to improve access to health care for Ethnic Americans. The author's conclusion is that President Clinton's ideas concerning health care reform would fail the needs of Ethnic Americans and the poor. The article presents a detailed look at the Health Security Act and what it would provide. According to the article, the Act would maintain a structurally flawed system which would fail to improve the nation's health infrastructure. The author points out the fact that there is no requirement on states to strengthen health care facilities in the inner city. Ethnic Minorities would not be assured that they would receive culturally competent care. Another failure of the act is that because three plans were proposed by the Clinton Administration, managed care will not succeed in controlling the nation's health care expenditures. Another failure of these three proposed plan is that many Ethnic Americans would be limited to basic coverage since health care continues to be based on employment.

This article shows that Clinton's health care policy would have not help the poor and Ethnic American. It clearly shows that some health care will not necessarily be better than no health care. The proposed policy continues the inadequate system that is currently in place. Much work is needed if this nation seriously hopes to adopt a health care system that is fair to Ethnic Americans and the poor. [Back]


Vernellia R. Randall, Racist Health Care: Reforming An Unjust Health Care System To Meet The Needs of African-Americans, 3 Health Matrix 127 (1993).

This article calls for programs to improve the health of African-Americans. The author calls for a system which guarantees complete access and the elimination of institutional racism. The author proposes several policy approaches that can meet this goal; (1) expanding insurance coverage, (2) targeting special health services to African Americans, (3) and using Title VI of the Civil Rights Act of 1964 to eliminate racist practices in the health care industry.

The author begins with a look at the differences between African-Americans and "European Americans" health status. The bottom line is that because of many factors outside their control, African-Americans are in poorer health and are subject to greater health risks than their European counterparts. The article then focuses on various racial barriers within health institutions that African Americans face. Specifically, the author looks at barriers in hospitals, nursing homes and physicians. The article then focuses on the above mentioned policies in order to solve the problems.

This article was one of the more thorough and well written articles that I read. The author submitted several proposals in order to solve a problem rather than just offering criticism of the current problem. Her proposals are logical and are well thought out. If only some of these proposals were seriously considered, health care in American would be moving forward and joining the systems in other first world countries. [Back]


Sidney D. Watson, Health Care in the Inner City: Asking the Right Question, 71 N.C. Law Rev. 1647. (1993).

This article examines the poverty of African-Americans. Lack of money causes many problems for African Americans. Many African-Americans are unable to afford preventative care and therefore tend to suffer more illnesses and become more sick than white Americans. Lack of funds also forces many African-Americans to live in urban areas where housing is cheaper. African-Americans living in these areas are exposed to many environmental health hazards. These health risks are complicated further by the fact that many Blacks are not able to secure access to health care. Studies indicate that federal budget cuts have forced many of the hospitals and clinics within the inner cities to close and leave the inner city. The remaining hospitals are mostly public, under-funded and overcrowded. African Americans are forced to wait long hours for care and many times cannot afford to take the day off, so they delay treatment. This delay causes health conditions to worsen and become more expensive to treat, thus taking limited resources away from others. Many must rely upon public inner city hospitals and clinics for care due to the fact that they live in poverty

In order to solve the problem, Watson suggests several ways for America to solve these problems. Watson urges the United States to implement uniform health care coverage which will allow citizens access to preventative care. Watson encourages medical schools to actively recruit more minority applicants who would be more likely to practice in urban areas. A third solution is more education and delivery. Community education programs should be set up to teach inner city residents about sex, drugs, prenatal care and infant health. The delivery of care should be at locations that have access to public transportation. The final suggestion submitted regards Title VI of the Civil Rights Act which was implemented to prohibit facially neutral polices and practices that have adverse effects on minority. According to the article, the Office of Civil Rights (OCR), which oversees enactment of Title VI was practically non-existent during the last decade. The act's regulations should be amended to provide express prohibited practices. The OCR should be mandated to collect data on compliance of the act.

This article does an excellent job of discussing the plight of poor African-Americans in our nation's cities. It is apparent that something must be done to address African-Americans' health problems. I strongly agree with the author's opinion that if nothing is done, many of these people will become more sick and require costly care which in the end, taxpayers will have to pay. I find his idea of universal health care for preventative care very important and very smart. My only concern is whether this will encourage more doctors to locate in the inner cities and help these people. [Back]


Durado D. Brooks Et. Als., Medical Apartheid: An American Perspective, JAMA Vol. 266, No. 19 (1991)

This article presents a scathing comparison of America's health care system to the one on place in the Republic of South Africa. The author argues that America's health care system segregates patients along socio-economic lines rather than race. In the end, the people that do not receive health care are African-Americans and Hispanic-Americans since many within these groups are likely to be poor. The author states that America's health care system is run like South Africa's health care system. Both systems are top heavy with bureaucracy and are inefficient in providing health care to its citizens. Many are pressed to find one location that is nearby that will provide comprehensive health care services. The article points out that in both countries, health care providers stay away from setting up offices in areas that are predominantly poor. This leaves public hospitals as the only health care alternative for the poor. These hospitals are understaffed, have limited resources and are force to care for a large number of people. The author then explains the price people must pay for this "public care" and the low quality of care that they normally receive.

The article represents a scary view of this nation's health care system. For many years, the United States has been directing a lot of attention to the discriminating policies of South Africa. In doing this, the country has been able to direct the nation's attention away from the terrifying similarities between the two nations. I could not believe these similarities, but this article does a good job in explaining them. With the election of Nelson Mandela as President of South Africa, many reforms have begun, unfortunately, America has not followed in implementing many of these policies. I only wonder how long will this country be able to direct its citizens' attention to events in other countries before they say enough and clamor for reform. One day we will wake up and find that the United States of America is the only industrialize country to view health care as a privilege and maybe then, we will reform our views on health care. [Back

Sheana Whelan Funkhooser & Debra K. Moser, Is Health Care Racist? 12 Adv. Nurs. Science 47 (1990)

In this article, the authors submit that although heredity may be a factor in many illnesses that confront African-Americans, a person's socio-economic status is the major reason the United States has a health care system that is plagued with disparities. The article focuses first on the racial conflict in American beginning in the pre-industrial area through modern times. Racial conflict has helped lead to disparities in the quality of health care received. It is argued that insurance and government programs have yet to assure access to quality care and several examples are given; co-payments, institutional barriers, ill use of resources. Traditional solutions have failed because victims of societal inequities are targeted and not structures. A major problem is that many programs reinforce the idea that poverty is unavoidable and people should accept this proposition. The authors suggest improved management of health care resources and education would be able to correct the problem.

I read this article and agreed with its premise, socio-economics does play a major role in producing disparities in health care. The problem I have with this article is that the solution proposed is rather general and vague. Here we have two health care professionals writing an article criticizing the current health care system, but they come up with a proposal that is much too simplistic and vague. It sounds like something a second or third year law student would suggest off the top of their head. The idea is simple, but in reality it will be very difficult to implement it, especially if a legislator with no experience in the health care field responsible for its drafting and enforcement. [Back]


Sidney D. Watson, Reinvigorating Title VI: Defending Health Care Discrimination--It Shouldn't Be So Easy, 58 Fordham L. Rev. 939 (1990).

This article focuses on how easy it is to defend a discrimination claim based on Title VI of the 1964 Civil Rights Act. Title VI prohibits both intentional and disproportional adverse impact discrimination in any program or activity that receives federal funds. (7)

Under disproportionate adverse impact discrimination, practices that are facially race neutral but treat minorities more harsh and cannot be justified are illegal. Courts have allowed defendants accused of disproportionate adverse impact discrimination to justify their actions by showing the policy is rationally related to a legitimate need. Watson urges that the Defendant's burden of justification should be to prove that the challenged practice significantly furthers a legitimate program objective which cannot be substantially accomplished through a less discriminatory means.

The Article provides good examples of how easy it is for a hospital to take action which is facially neutral but has a disproportionate impact on minorities. The proposed standard is not impossible for a defendant to meet, but would make the Defendant consider other proposals instead of opting to make the quick fix. [Back]


Howard E. Freeman, Et. Als., Americans Report on Their Access to Health Care, 6 Health Affairs 6 (1987).

This article reports that there has been a deterioration in access to medical care for the nation's poor, minorities and uninsured. The article basis its conclusion on a study conducted by the Robert Wood Johnson Foundation. The study reports four findings with regards to the access to care minorities receive; (1) American's overall use of medical care has declined in terms of visits to physicians, (2) Access to physician care for individuals who were poor, black or uninsured decreased between 1982-86, (3) Ethnic minorities receive less hospital care than European Americans that suffer from the same illness, and (4) Many Ethnic minorities under-use important health services.

Although this article was published in 1987, I found that overall, the same problems continue to haunt the health care system in the United States. Ten years have passed and this nation is still in the same position, if not worse than it was ten years ago with regards to the issue of minorities access to health care. In a nation that has the best technology in the world and breakthroughs everyday, it would seem that we could come up with a solution to allow everyone access to care. [Back]



1. Lau v. Nichols 414 U.S. 564 (1977)

2. Catherine G. Vanchiere, Stalled on the Road to Health Care Reform: An Analysis of the Initial Impediments to the Oregon Demostration Project, 10 J. Contemp. Health L. & Pol'y 405 (1994)

3. Robert J. Kuczmarski et al., Increasing Prevalence of Overweight Among US Adults: The National Health and Nutrition Examination Surveys, 1960 to 1991, 272 JAMA 205 (1994).

4. Amy Jurevic, Disparate Impact Under Title VI: Discrimination, By Any Other Name, Will Still Have The Same Impact, 15 St. Louis U. Pub. L. Rev. 237, 242 (1996).

5. Alexander v. Choate 469 U.S. 287 (1985).

6. Marianne L. Engleman Lado, The Role of Civil Rights Litigation and the Relationship Between Burdens of Proof and The Experience of Denial, 60 Brook. L. Rev 239, 260 (1994).

7. 42 U.S.C. Section 2000d (1982)


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Professor Vernellia R. Randall
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The University of Dayton School of Law
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