New evidence finds disparities aren't usually due to bias

But researchers say cultural barriers should not be ignored as physicians look to improve the health care system.

By Kevin B. O'Reilly, AMNews staff. Aug. 6, 2007.

Two recently released studies added to the increasing weight of evidence suggesting that health care disparities are due mostly to where minorities receive treatment rather than to racism or cultural insensitivity.

An Archives of Internal Medicine study examined how 123 teaching hospitals scored on Hospital Quality Alliance measures in caring for more than 320,000 patients. After adjusting for where minority patients were treated, the researchers found racial and ethnic disparities were vastly reduced or even eliminated. And a report released by the Commonwealth Fund, a health care policy nonprofit, surveyed nearly 3,000 patients and determined that those whose physicians provided a medical home received more equitable treatment.

"These data add to a briskly growing literature showing that the most profound effects on health differences by race are due to socioeconomic factors, not bias on the part of physicians," said Sally Satel, MD, co-author of The Health Disparities Myth: Diagnosing the Treatment Gap, published in 2006 by the conservative American Enterprise Institute.

An editorial accompanying the June 25 Archives study came to a similar conclusion. The article's findings "demonstrate that most disparities in the quality of hospital care depend on where you seek care, not on your race [or] ethnicity," wrote Memphis internists James E. Bailey, MD, MPH, and Laura R. Sprabery, MD.

They added that because care for minorities is heavily concentrated in underfunded urban hospitals, "the most pressing inequalities in health care may be driven by economics."