Substandard health care for minorities?

  1. I thought this article was rather disturbing. Comments?

    (You have to register with the NY times to view the article, but registration is free).
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  2. 65 Comments

  3. by   Q.
    Hmmm I thought it was interesting, but questionable. I'd like to read the entire report.

    I think there might be aspects that are not included, such as the factor that typically minorities are on Medicare/Medicaid, which has a low(and slow) reimbursement rate for hospitals. In fact, our county hospital which saw primarily these groups of people went belly-up, as a result of no insurance or poor reimbursement from Medicare/Medicaid. (30 cents on the dollar)

    Also, the mention of the recovery rates among Whites and Blacks from lung CA, etc: I think there may be other variables not addressed, such as pre-existing conditions that may effect recovery and response to tx, also, I've read studies that show that minorities do not really seek primary care; they wait until the condition is life-threatening. They don't see primary care for a variety of reasons: some are cultural, some are decreased access to care other than an ED, some is fear, etc.

    I think the perception of decreased care of minorities can't fall soley on one factor alone, such as HMO's. EMTALA requires all patients be treated upon arrival and I think most hospitals take this seriously. But let's face it, physicians are at a point now where they order tests or not order tests to ensure reimbursement for their services based on ICD-9 codes. It's tragic, but reality. And just a fraction of what's wrong with healthcare.
  4. by   Stargazer
    Susy, you can find more information (including a link to the full study) here, and more info from the CDC here.

    I think some of the factors you mentioned are definite influences, so it's really important to look at the whole picture, from a lot of different angles. The problems--and the solutions--aren't going to be easy or straightforward, but they do need to be studied further.
    Last edit by Stargazer on Mar 20, '02
  5. by   fergus51
    It sounds like it's more socio-economic status and education level than ethnicity alone. Health Canada has done a lot of publicizing the social determinants of health, low income being one. Some of their findings suggest that poverty plays a more important role than ethnicity, because wealthy minorities tended to have better health than poorer ones (and better than poorer caucasions).

    Unfortunately though, our aboriginal population has poorer health on average, even those living in cities far from the reserve, so I do believe ethnicity is a part of it. They are probably the most researched minority group in Canada and their health stats are appaling. Have you read any articles on marginalization and how it impacts health? It sounds like the same concept to me. One article that I read from the journal of Advanced Nursing Science 1994, 16(4), p.23-41. is quite good. It talks about how research and health education (of docs and nurses) has tended to ignore the health of those who are not of european descent, so it is no wonder that the health care system may not have developed strong plans for decreasing illness in other minority populations.
  6. by   Q.
    Wow Fergus that is interesting (the article you cited) I suppose that would be true. I think since the publication of that article, at least in the States, research on minorities has increased. I know it was part of my BSN curriculum, although what was disturbing to me was that I was under the impression that Cultural Diversity in Health Care (as the course was called) would focus on cultural differences in health and disease states (sickle cell, htn, etc) NOT how to be more culturally "sensitive." After reading article after article, and seeing more and more "handbooks" on cultural sensitivity, I've come to the conclusion that there are waaaayyy to many subcultures of subcultures, to group any one of them into some sort of predictable category to impact care.

    Poverty would play a role in poor health, however most of those in poverty here are typically your minority groups (women and children included in that).

    I've been interested in your health care system for quite some time. I don't think the US should have a system like yours (based on what I know) but I think a re-emphasis to primary care would help. I think nursing holds the key to that.

    Stargazer thanks for the links.
  7. by   fergus51
    I think our health care system would be a lot better off if it practiced what it preached (like more primary health care!). It's funny, cause I don't particularly like the American model of care either. There's a middle ground that can't seem to be found.

    The poverty thing among minorities is exactly what I was trying to get at. The social determinants of health approach makes a lot of sense to me. They include things like violence, low educational levels, unsafe working and living conditions, etc. which all tend to be worse off in the minority groups. When I think of my least healthy patients, they are seldom white, well off or well-educated.

    Unfortunately I think this gets too much lip service and not enough action. If you ever work among a group of aboriginals (like I did in school), you'll often find it hard to get them to trust you or get involved with health care because of this. They have been studied to death, but seen almost no results from it which makes it very difficult for the new public health nurse. You can be seen as some stuck up white girl who's only there for the money and will be gone when the gov't pays off her student loans. It's tough! I don't know if the situation is similar in the States. Where I worked there we didn't have a large minority pop. at the hospital.
  8. by   Brownms46
    Originally posted by Susy K
    Hmmm I thought it was interesting, but questionable. I'd like to read the entire report.

    I think there might be aspects that are not included, such as the factor that typically minorities are on Medicare/Medicaid, which has a low(and slow) reimbursement rate for hospitals. In fact, our county hospital which saw primarily these groups of people went belly-up, as a result of no insurance or poor reimbursement from Medicare/Medicaid. (30 cents on the dollar)

    Also, the mention of the recovery rates among Whites and Blacks from lung CA, etc: I think there may be other variables not addressed, such as pre-existing conditions that may effect recovery and response to tx, also, I've read studies that show that minorities do not really seek primary care; they wait until the condition is life-threatening. They don't see primary care for a variety of reasons: some are cultural, some are decreased access to care other than an ED, some is fear, etc.

    I think the perception of decreased care of minorities can't fall soley on one factor alone, such as HMO's. EMTALA requires all patients be treated upon arrival and I think most hospitals take this seriously. But let's face it, physicians are at a point now where they order tests or not order tests to ensure reimbursement for their services based on ICD-9 codes. It's tragic, but reality. And just a fraction of what's wrong with healthcare.
    Susy k,


    I think your post was very bias, and shortsighted in the way it was written. Your generalization of minorities ...where you posted.."typically minorities are on Medicare/Medicaid", was a generalization I found hard to believe you would even put in print.
    And your statement: "that minorities do not really seek primary care; they wait until the condition is life-threatening." I would have expected you to prefix your statements with some...as ALL minorities are NOT poor...and NOT undereducated, are NOT on Medicare/Medicaid, and do NOT "wait until the condition is life-threatening. Even if you read this somewhere...I would think that you would still prefix this statement! Please check out the following link..as to just who is in the majority when it comes to being poor in America, and who is with/without insurance, and covered by medicare/medicaid.

    http://ferret.bls.census.gov/macro/0...th/h04_000.htm
    http://www.census.gov/hhes/hlthins/cover95/c95tabc.html

    My mother who was(as she is deceased now)...worked in Erie County for the Welfare dept for almost 20yrs, and she was appalled at the number of whites receiving public assistance, and mediciad.....some even with homes. Since we had all been led to believe that mostly Blacks/hispanics were the majority of those who received public assistance. Most of my mother's clients were white...and lived in the suburbs of Buffalo...not the inner city. Such as East Aurora, and Cheekatwaga.

    I also agree with the report presented in this thread...just as women have a hard time getting better health than white males in this society...so do minorities. "I" believe racism is alive and well in many forms in our society...and YES even healthcare!

    Quote: The report said the differences exist even when insurance, income, age and the severity of the disease are the same for both groups.

    I just felt another view point needed to be represented in this discusion..
    Last edit by Brownms46 on Mar 21, '02
  9. by   P_RN
    I have seen the disparity with my own eyes. SC has recently (like in the past 10 years or so) starete having a fairly large number of Hispanics move in.

    I saw one doctor refuse to fix a lady's fractured femur "because she probably won't pay and will just go out and get in another wreck." -that one went to the ethics committee. The nurses were the ones translating and making arrangements for her family. She was discharged straight out of traction and in a long leg cast-not an appropriate measure. We later heard she was admitted to another hospital and had her surgery. (By a REAL doctor.)

    I saw two Mexicans who both had "hangman's fractures" being treated by two different doctors-both equally skilled in my opinion. One doctor was AA the other White. NEITHER doctor gave the level of care I have seen them give with their other patients. It was not communication, money or residency. They both spoke English, had very good jobs with health insurance and were here with legal papers.
    Again the nurses stepped in. The wives were here also, but with the husbands out of work, their financial status became shaky. The social worker and the nurses arranged for an apartment next to the hospital, transportation and even got the ladies a washer/dryer. Both men were discharged with no permanent injury though both were in halo traction. They both returned to Mexico I heard.

    I saw one absolutely fantastic AA doctor who was on call for a White doctor get thrown out of a patients room. I almost cried over that one, because the one he was covering for, was the jerk in scenario #1. That patient did not know that he traded treasure for trash.

    Equality wears many hats. Inequality the same. I like to believe that in most cases it is not the nursing staff who are dropping this ball.

    It's 2002 and time for all this to work out. It is a fact like the article states there is disparity. Some may very well be on account of minority financial states. It may also be as a result of certain ethnic "illnesses" that prefer one over the other (Im thinking SSA here). All I know is I hate knowing that this still goes on .
  10. by   oramar
    I think at least part of the problem is access. After having the experience of living in a low income neighborhood and moving to a more affluent comunity I can speak from experince. Poor people have to travel great distances by public transportation to see mediocre physicians. Out here in the burbs I have a car and a lot of good doctors near by. Why are the better physicians out here in the burbs? Well you know the answer to that, money. I know for a fact that the physicians out here freqently do not accept medicade patients or are at least very choosy about which ones they take. I have had many long conversations with the staff of many suburban physicians about that very thing and I know what questions to ask. If I were still poor and got sick I would take a cab to a hospital serving a well to do neighborhood. They might try to turf you but it is illegal.
  11. by   Q.
    Hi Brownie,

    I don't think my post was all that bias. There has been report after report on the amount of non-insured or underinsured (ie Medicare) minority groups (Sultz, H. & Young, K. 2000 - . Health Care USA - Organization and Delivery)

    Minority groups have been including elders, women and children as well, so I don't think my statement was limiting of these people and referencing only Blacks and Hispanics. I also stated that these groups of people have been reported to NOT access care (Sultz, et al) for a variety of reasons: some cultural reasons, some no transportation, all factors r/t their socio-economic status. My statement with regard to that was focusing on THOSE minorities that are on Medicare, or NO insurance. I shouldn't have to prefix every statement. Once the generalization is made, or the sub-groups identified, it should carry over throughout the entire manuscript. Perhaps not, and that could be my fault.

    So... to clarify....OF the minority groups that have poor care, MOST have been identified as being underinsured or not insured. Of the minorities that have any insurance, MOST have decreased access to care for a variety of reasons, which has been identified as a contributing factor to acuity levels WHEN care is finally saught, which can contribute to recovery.

    P, I have never witnessed such events as you described in your hospital. But I have seen hospitals not being able to pay the bills as a result of seeing and treating too many patients who can't pay. Like I said, our county hospital went bankrupt as a result. Our other inner-city hospital is on the verge.
  12. by   Brownms46
    Originally posted by Susy K
    Hi Brownie,

    I don't think my post was all that bias. There has been report after report on the amount of non-insured or underinsured (ie Medicare) minority groups (Sultz, H. & Young, K. 2000 - . Health Care USA - Organization and Delivery)

    Minority groups have been including elders, women and children as well, so I don't think my statement was limiting of these people and referencing only Blacks and Hispanics. I also stated that these groups of people have been reported to NOT access care (Sultz, et al) for a variety of reasons: some cultural reasons, some no transportation, all factors r/t their socio-economic status. My statement with regard to that was focusing on THOSE minorities that are on Medicare, or NO insurance. I shouldn't have to prefix every statement. Once the generalization is made, or the sub-groups identified, it should carry over throughout the entire manuscript. Perhaps not, and that could be my fault.

    So... to clarify....OF the minority groups that have poor care, MOST have been identified as being underinsured or not insured. Of the minorities that have any insurance, MOST have decreased access to care for a variety of reasons, which has been identified as a contributing factor to acuity levels WHEN care is finally saught, which can contribute to recovery.

    P, I have never witnessed such events as you described in your hospital. But I have seen hospitals not being able to pay the bills as a result of seeing and treating too many patients who can't pay. Like I said, our county hospital went bankrupt as a result. Our other inner-city hospital is on the verge.

    Hi Susy K..

    Thank you for taking the time to clarify...as it is much appreciated...


    Now..I believe the reason most do not seek healthcare is because they're poor, and do not have access to healthcare...and that culture is the least of the reason. If you have no insurance...no money...then you're more likely to not seek healthcare until you have no choice.

    But the article stated: the differences exist even when insurance, income, age and the severity of the disease are the same for both groups.

    Meaning that even though ALL things being equal "they" still were treated differently. Unfortunately ....this IS a fact in this country.


    I have a Hispanic friend who took her son to a local hospital...also in S. C.. She told them her son was active duty military, and that he was on leave at home after having an appendectomy d/t a ruuptured appendix. She asked if they needed his military ID card...they said no. He was complaining of pain...well after he had been improving. He was not treated appropriately...and to make a long story short...was sent back home. Later she noted on the D/C form...that they had written that he had NO insurance. The son return to his military base...only to return to surgery...as he was found to have a bowel obstruction....d/t adhesions, and went back to surgery within a week of returning from S. C.. Doesn't say much for how well miniorities are treated in S. C.. does it. It also says a lot about the fact...that this hospital didn't even TRY and determine whether or not this young man had insurance. "They"( those who saw him)...just ASSUMED he didn't!
  13. by   semstr
    I can't even imagine discussing a thing like "minorities care"
    People, who need care, get care!
    Of course we "the better off", have to pay sometimes, but hey, you know how quickly life can change?

    Example: the big, big "refugee-population" we have here. No money, no insurance, no place to live, nothing.
    A lot of these human-beings are sick, very sick, either physical or psychological. Especially the kids.
    They have to be treated.
    The little money the country I live in now, gets from the UN-Refugee-Help, is definetly not enough.
    So it is my ( and thousands of other people living in Austria) money and hospitalbed and doctor and nurse.
    But as I stated before, you'll never know how your life is going to be in, say a few years time.
    We all could be a minority then.

    Take care, Renee
  14. by   Q.
    True, Renee, very true. But money doesn't grow on trees. We can't pay for everything. We'll ALL be broke pretty soon.

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