Does race affect how the medical-care system deals with patients?

AEI Online:

Many experts today insist that race profoundly affects how the medical-care system deals with patients and that a black patient will get inferior care. Is this true? In The Health Disparities Myth: Diagnosing the Treatment Gap, authors Jonathan Klick and Sally Satel examine recent research bearing on this question.

Klick, a legal scholar and health economist, and Satel, a physician, conclude that differences in treatment do indeed vary by race but not because of it. People living in places with inadequate medical resources tend to receive poor care, whether they are black or white. It is not a question of physician bias, according to Klick and Satel. The authors found that socioeconomic status and geographic location––not race––make a much greater difference in a person’s health and the quality of care he receives. As such, policy prescriptions to increase “cultural competence” (e.g. racial sensitivity training) or medical school affirmative action do not make sense.

The notion that physicians are biased against minorities––overtly or subtly––has acquired considerable and unmerited weight in both academic literature and the popular press. It enjoyed a great boost in visibility from a 2002 report from the Institute of Medicine (IOM), part of the National Academy of Sciences, called Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.

The IOM report concluded that “bias,” “prejudice,” and “discrimination” in the doctor-patient relationship were major causes of the difference in treatment and, by extension, the poorer health of minorities. Since the report was issued, many medical schools, health philanthropies, policymakers, and politicians are proceeding as if physician “bias” were an established fact.

In The Health Disparities Myth, the authors explore additional explanations for differences in the quality of health care provided to blacks and whites. Data show that third factors, especially geographic and socioeconomic factors, generate most of the treatment gap. White and black patients, on average, do not even visit the same population of physicians, making the idea of preferential treatment by individual doctors a far less compelling explanation for disparities in health than has been claimed.

Don't Despair over Disparities