Black-white disparities in health care

Article Abstract:

Differences in the quality of health among people in the United States are persistent and often substantial, with considerable disparity between white and black people. Infant mortality among blacks is twice that of whites, and whites can expect to live an average of six years longer. Differences also exist in need for and access to health care. It appears that even when blacks are treated, they are less likely to receive certain kinds of treatment. The American Medical Association (AMA) supports a policy of equal access to basic medical care. A review of recent studies that have documented specific inequities is provided. These include angiography (examination of the vessels that deliver blood to the heart itself), cardiac bypass surgery, angioplasty (repair of those vessels), hemodialysis for kidney disease (passing blood through a filtering machine), and kidney transplantation. Medicare did not pay for outpatient drugs prior to 1987, which are a necessity in the case of kidney transplantation. Treatment of some conditions, such as pneumonia, was found to be more aggressive for white people. Differences in the rates of caesarean sections were noted, with more being performed for white women. Possible reasons for these disparities are discussed and it is suggested that income differences are probably the most important explanation. Racial prejudice is probably another factor. Regardless of the reasons, racial disparities in medical treatment must stop. The Council on Ethical and Judicial Affairs of the AMA suggests expansion of access to health care, greater awareness on the part of physicians, and improved practice parameters, should be given high priority to correct the situation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects

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The Patient Self-Determination Act: on balance, more help than hindrance

Article Abstract:

The Patient Self-Determination Act requires health care providers receiving Medicare and Medicaid to inform patients of their rights to refuse treatment and to prepare advance directives. Advance directives are a way for competent patients to indicate their consent or refusal of health care under certain conditions, and to appoint a proxy to make decisions in the event the patient becomes incapacitated. The act will assist physicians, patients, family members and other surrogates in dealing with the difficulties of decision-making. Although the living will is often vague, it is still better than trying to remember what the patient may have said about clinical and terminal-care decisions. Patients will not be required to complete living wills or appoint proxies, and patients with proxies and living wills cannot be treated any differently from those without. Physicians faced with the decision to withdraw life-sustaining equipment often find it difficult to determine who exactly has the authority to make the decision, and the range of that person's authority. Not everything that a proxy decides is legally enforceable. Medically inappropriate, useless or harmful treatments or tests, and initiation or continuance of treatment that the patient would not have wanted, need not be undertaken. Such decisions should be reviewed by an ethics committee. There is a concern that cost containment is a stronger motivation for medical administrators than patient well-being, and internal procedural review mechanisms, such as ethics committees or bedside ethics consultants, may help to prevent abuse. When and how discussion of advance directives should take place is considered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Living wills, Durable power of attorney, editorial

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Patient Preferences and Health Disparities

Article Abstract:

Allowing patients to choose the treatment they prefer may reinforce disparities in health care provision. Many studies have shown that minority patients do not receive the same treatment as white patients. This may be in part because they are misinformed, or are resigned to their status and do not request appropriate treatments.

Analysis, Consumer preferences

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