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
Annotations
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]
Footnotes
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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