Perspective: The Spectrum of Health-care Disparities in the USA

Abstract

In 2002, the Institute of Medicine (IOM) issued Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, a report on disparities in quality of care within health-care settings. This landmark report succeeded at placing the issue of health disparities squarely on the nation's health policy agenda, leading to increased attention and resources devoted to understanding and ultimately solving this long-standing and vexing problem. Unequal Treatment (The IOM Report) focused on health-care disparities, which are to be distinguished from health status disparities (which are covered in another section of this book). While health status disparities relate to disparities in the pattern of morbidity, mortality, and disability, health-care disparities relate to disparities within the health-care system: access to and utilization of health services, and quality of care received. The objective of this review is to summarize the recent literature on health-care disparities. Specifically, this review examines racial/ethnic discrimination within health-care settings. In selecting articles for inclusion in this review, we established a set of criteria to focus on the scope of the project. To be included in this review, articles had to meet the following criteria: (1) based on a US population; (2) published in English in a peer-reviewed journal, book, or government or other report; (3) topic of the article is racial/ethnic differences in health services or racial discrimination or racism in the health-care setting. Studies of discrimination outside of the health-care setting are not included. We searched the National Library of Medicine PubMed database, which combines the Medline and Pre-Medline databases. PubMed includes bibliographic listings from more than 4,000 biomedical journals published in the United States and 70 other countries. It contains over ten million citations dating from 1966 to the present. PubMed is the most widely used computerized search tool for medical information and is very comprehensive. In addition to articles selected via PubMed, we searched the reference list from each article that met our criteria to search for additional articles that were not detected in the PubMed searches. This included book chapters and other papers that were not published in peer-reviewed scientific journals. After the elimination of duplicates, this procedure resulted in a total of 496 articles that met the inclusion criteria. Each article was summarized with respect to its study objectives, data sources used in the study (administrative data, vital data, medical records, questionnaire, and others), the specific measure(s) of discrimination used in the study, and the study's key findings.