Minorities feel cheated in health care

Marie_LPN, RN, LPN, RN · Sep 24, 2003

I had to laugh at this a little. Not because i think it's actually funny, but we have the opposite here.

Angers me that we have people up here getting whatever they need healthwise due to the fact that they are not of this country's origin. I have a big problem with this since i pay my taxes (most here do not) and i can't even use ANY of the health services that my taxes GO for because i am a white woman who "makes too much money". Yeah, too much, never know it from my end, school tuition aside.

Pardon the mini-soapbox.

Brownms46 · Sep 24, 2003

Documenting the Disparities

"Disparities in the health care delivered to racial and ethnic minorities are real and are associated with worse outcomes in many cases, which is unacceptable. The real challenge lies not in debating whether disparities exist, because the evidence is overwhelming, but in developing and implementing strategies to reduce and eliminate them."

-- Alan Nelson, retired physician, former president of the American Medical Association and chair of the committee that wrote the Institute of Medicine report, Unequal Treatment: Confronting Racial and Disparities in Health Care

http://www4.nas.edu/onpi/webextra.nsf/44bf87db309563a0852566f2006d63bb/1af2dc4ae9257fb385256b81005f0252?OpenDocument

Racial and ethnic disparities are, with few exceptions, remarkably consistent across a range of illnesses and health care services. In some cases, differences in treating heart disease, cancer and HIV infection partly contribute to higher death rates for minorities. Although socioeconomic factors such as lack of health care facilities in minority communities or inability to afford high co-payments play a large role, racial and ethnic disparities in health care persist regardless of income or insurance, says the report. Below are just a few examples from hundreds of studies conducted during the past decade on minority disparities in health care.

Cardiovascular Disease

Racial and ethnic disparities are most evident in cardiovascular care. For example, minorities are less likely to be given appropriate cardiac medications or to undergo bypass surgery.

Cancer

Several studies show significant racial differences in who receives appropriate cancer diagnostic tests and treatments.

Stroke

Although African-Americans suffer strokes as much as 35 percent higher than whites do, several studies have found that they are less likely to receive major diagnostic and therapeutic interventions.

Kidney Dialysis, Transplants

Minorities are less likely to be placed on waiting lists for kidney transplants or to receive kidney dialysis or transplants.

HIV/AIDS

Minorities with HIV infection are less likely to receive antiretroviral therapy and other state-of-the-art treatments, which could forestall the onset of AIDS.

Asthma

Asthmatic African-Americans are less likely to receive appropriate medications to manage chronic symptoms.

Diabetes

Although minorities have a much higher rate of death and illness from diabetes, the disease is poorly managed among minority patients, says the report. In a study of nearly 1,400 Medicare patients, diabetic African-Americans were found less likely to receive key diagnostic tests.

Minorities are also more likely to receive certain less-desirable procedures, such as lower limb amputations for diabetes and other conditions.

Maternal and Child Health

Despite several federal and state initiatives to promote healthcare access to pregnant women and their children, racial and ethnic disparities persist in maternal and child healthcare. For example, minority women are more likely to undergo cesarean deliveries. And minority children are less likely to receive prescription medications.

Mental Health

In psychiatric care, African-Americans are more likely to be diagnosed as psychotic, but are less likely to be given anti-psychotic medications. They are more likely to be hospitalized involuntarily, to be regarded as potentially violent, and to be placed in restraints. A recent report from the U.S. Surgeon General illuminates the striking disparities in access and availability of mental health services for minorities, and calls for action to improve the quality of mental health care available to racial and ethnic minority populations.

fergus51 · Sep 24, 2003

Same can be said for women and people of lower educational and socio-economic backgrounds. We need to make health care better for everyone and start focusing more on the determinants of health instead of just diseases.

pickledpepperRN · Sep 24, 2003

Originally posted by LPN2Be2004
I had to laugh at this a little. Not because i think it's actually funny, but we have the opposite here.

Angers me that we have people up here getting whatever they need healthwise due to the fact that they are not of this country's origin. I have a big problem with this since i pay my taxes (most here do not) and i can't even use ANY of the health services that my taxes GO for because i am a white woman who "makes too much money". Yeah, too much, never know it from my end, school tuition aside.

Pardon the mini-soapbox.

No pardon needed. It is not fair that you are working, going to school, and paying taxes yet have to pay even more for healthcare.

I am blessed with good health. While not begrudging anyone "getting what they need" What about you?

I work at hospitals in both the wealthy and poor parts of the city. All try to staff to the bone (some even deeper, to the marrow).

At some facilities like the one where I am on staff, the nurses work very hard to keep staffing safe. Others do not.

Guess my point is that even if you are wealthy, well insured, and have a great doctor you may be hospitalized and share your nurse with so many other patients you suffer. Some patients are not saved in time. Nurses doing their best do not discriminate, not in my nursing in five decades.

Still the statistics tell us something. It is worth finding the reason for early death. It is only recently that women and heart disease was noted by the public. Catheters for interventional angiography in sizes for most women did not exist.

Oh well.

Sorry for my soapbox too!

Marie_LPN, RN, LPN, RN · Sep 24, 2003

I worked at a place that hired a lot of Hispanic workers. We had a woman, part time employed, who pulled a shoulder muscle so she goes to the free clinic and gets checked out. This doctor sends her to Univ. of Va hospital to get some sort of scan done on it. All expenses paid by the state.

My problems with this were: she's been here for 5 years, still is not a legal citizen in this country, because when the INS came to work, she was no where to be found that day. Taxes are NOT being taken out of her check, but because she IS a minority she does qualify for free healthcare. That she's not even paying for. I know this because i did her paperwork since she doesn't read or speak a word of English (after 5 years how can you NOT know ANY english words).

Meanwhile, by earning around 10,000 a year, i make too much money. I make too much for the Free Clinic. If i go to the ER (don't have insurance, can't afford it) i get the whole bill, to make payments on. BUT had i been a prior resident of another country, i'd have a charity group picking up my ER tab!!!!

And i'm still trying to figure this one out. I did a week of clinical at the health dept. (the part where the pelvic exams and birth control are done). Since i do not have kids, and make too much money, i have to pay 3/4 of the cost for these services myself. Now had i walked in with 3 kids and said that i'm NOT a US citizen, it's taken care of by an advocacy group.

sjoe · Sep 24, 2003

People with a victim mentality will always believe they are getting the short end of the stick, no matter what the situation actually is. This kind of whining is always easier than taking responsibility for oneself.

The ONLY population in the U.S. that the US Supreme Court has deemed ENTITLED to health care is the jail and prison inmate population. And this population is MORE than representative of the groups identified in the original post. So, from that point of view, they are entitled to, and receiving, better healthcare than the rest of us.

jjjoy, LPN · Sep 24, 2003

Minorities feel cheated in health care

This type of headline helps foster misunderstanding between groups. "Feel cheated" is so vague. Many people "feel cheated" about lots of things in life so what makes this different? "Evidence of bias in healthcare for minorities" would be more specific. But not as attention grabbing and emotion stirring as the actual title.

The Institute, an independent body that advises Congress and the federal government, suggested that deliberate or unconscious bias by doctors and other health care providers may worsen the problem.

Deliberate bias - THAT is cheating and while it can't be prevented 100% of the time (because people will be stupid), there must be a system to review complaints and discipline inappropriate care choices. Unconcious bias is more difficult to deal with and we can't expect it to just disappear by an act of will or legal recourse. That will take time and effort on the part of all involved. It is important for outsiders to make sure those inside healthcare continue to work on it.

Those surveyed felt that cultural and language barriers were most to blame for the disparities while more than half felt doctors and nurses treat minority patients differently than white patients.

Language and cultural differences ARE barriers that need special interventions to get around - such as translators. There's no one-time solution; it will take extra work for each and every interaction than if the interaction were between two people of the same language and culture. There WILL be more room for miscommunication. (That's not to say that it's ALWAYS easier to work with and communicate with people of the same language and cultural background!) We do our best to treat everyone the same way, but the fact is that everyone IS different. Minorities generally being treated "differently" isn't inherently bad as long as the treatment is competent, respectful and meeting their needs. After, the differences might be to ACCOMODATE the pt preferences! Minorities being treated more poorly than non-minorities (all else equal) is a problem we need to look into. Anyone being systemically mistreated is a problem and we all need to fight any such systemic problems.

When we see different disease rates and outcomes for any group, that IS reason for concern. Then we need to explore the cause and create effective change where possible and not end the discussion prematurely. I think people on sides of this isse would do well to be reminded that noticing and documenting the difference is the START of research, not the CONCLUSION.

tonchitoRN · Sep 24, 2003

lpn2b2004 - since you seem to think the hispanic is so much better off than you why don't you quit your job or work part-time like her and see how much better off you are.

only when you can walk in her shoes can you be so critical.

SharonH, RN · Sep 24, 2003

This doesn't surprise me one bit. After all, working in healthcare I see the attitudes and actions of my co-workers towards minorities and the perceptions are sadly often(not always) correct.

nekhismom · Sep 24, 2003

LPN......

I live in VA also, and I feel I need to correct some of your misconceptions. First off, the state of VA requires hispanic immigrants to pay taxes. this applies even if you are illegal. I know because I translate for people regarding this sort of thing. Secondly, in my area, a lot of minorities do NOT qualify for free health care. In fact, I have volunteered and INTERPRETED SPANISH at my community's free clinic. People are asked to make a donation before service is rendered, but if they don't have it, that's ok. NOBODY is denied service as long as the clinic has the staff and capacity to serve the people needing the service. REGARDLESS OF YOUR INCOME. It seems to me that you are speaking of Medicaid or other state and federally funded health care programs. Well, guess what??? I KNOW LEGAL AND ILLEGAL IMMIGRANTS WHO ARE NOT ELIGIBLE FOR MEDICAID. SOME MAKE TOO MUCH MONEY. If you are not a citizen or resident alien, you do not get help for yourself. If your child is a citizen, s/he is eligible for medicaid IF you meet the STRINGENT requirements.

Thirdly, just because she was not at work on the day the INS was there does NOT mean she is illegal. Perhaps she was there and you did not see her, perhaps she was ill or had another personal issue, maybe it was her day off. If you did not ask her, you have NO BUSINESS assuming what the circumstances were.

Next time you go to a country where NOBODY speaks your language and EVERYTHING is foreign and scary, THEN you can assert how UNFAIR it is to have someone assist you. Until then, do NOT speak badly about people you DO NOT understand. As a nurse, ASSUMPTINS can get you in a lot of trouble and could even cause you to lose your license. You should know that by now. Also, your personal prejudices are things that should be left at home. As a nurse, you should be compassionate for all people, regardless of race, language spoke, national origin, religion, or anything else you can think of that might cause you to discriminate.

Bottom line is don't judge people until you see what it is like to be in their situation.

Jen2 · Sep 24, 2003

Sorry but I too have $50.00 taken out of my paycheck to pay for my healthcare as well as a $10.00 co-pay. In the year of 2003 I thought we were getting away from all of the "white people are treated better thing", but I guess not. I have a 3.7 GPA, and am riding soley through school on student loans, however if I were a minority teetering on academic porbation I'd get a state and federal grant. That being said I am done with this topic.