One in 4 older Black and Hispanic Americans have felt discriminated against by doctors and other health care professionals who have ignored their health concerns or treated them unfairly, according to a new Commonwealth Fund report.
The report authors suggest that the perceived disparities have real consequences. Those who have experienced discrimination in a health care setting were more likely to have worse health status, face economic hardships and be more dissatisfied with their care than those who did not experience discrimination.
Discrimination in Health Care
Percentage of older adults who report racial or ethnic discrimination when seeking health care:
- 25 percent of Black respondents
- 23 percent of Hispanic respondents
- 3 percent of white respondents
Women are more likely say the health care system often treats people differently because of their race or ethnicity:
- 49 percent of older Black women say this
- 34 percent of Hispanic women say this
Discrimination affects care:
- 27 percent of older adults who experienced discrimination in health care said they did not receive the care they felt they needed
Source: The Commonwealth Fund
“The consequences of health care discrimination against older adults of color are serious. People are not getting the care they need, their concerns are being ignored, and their health is suffering as a result. As a society, we can work to end discrimination in the health system, first by recognizing discrimination and then actively working to dismantle it,” Michelle M. Doty, lead study author and Commonwealth Fund vice president for organizational effectiveness, survey research and evaluation, said in a statement.
The report, “How Discrimination in Health Care Affects Older Americans, and What Health Systems and Providers Can Do,” was based primarily on an analysis of the Commonwealth Fund 2021 International Health Policy Survey of Older Adults. The survey of 1,969 U.S. adults age 60 and older was conducted from March 11 to May 27, 2021. In clinics, hospitals or doctor offices, discrimination can include providers dismissing a patient’s symptoms or health concerns, offering different treatment based on a patient’s type of insurance, or not providing care in a patient’s preferred language, according to the report.
Among the survey findings:
- Women across all racial and ethnic groups are more likely to believe the health care system discriminates based on race and ethnicity — none more so than Black women, at 49 percent, compared with 40 percent of Black men. Among white respondents, 37 percent of women and 26 percent of men reported this, as did 34 percent of Hispanic women and 16 percent of Hispanic men.
- Twenty-five percent of Black and 23 percent of Hispanic respondents said they had been treated unfairly or felt that their health concerns were not taken seriously because of their racial or ethnic background. The same was true of just 3 percent of older white adults.
- Nearly half of those who experienced such discrimination reported being in fair or poor health, twice the rate of those who did not experience discrimination. Three-quarters of adults who have felt discriminated against have three or more chronic conditions or need help with daily activities.
- More than 4 in 10 respondents who reported discrimination said they are somewhat or not at all satisfied with the quality of their care, about double the rate for those who did not report discrimination.
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Disparities appear greatest in U.S.
Older adults in the U.S. were significantly more likely to report racial and ethnic disparities in the health care system than those in 10 other high-income countries. In the U.S., 32 percent agreed the health care system treats people differently because of their race or ethnicity — nearly double the percentage in Canada, the country with the next-highest rate, at 17 percent. Adults age 65 and older were also surveyed in Australia, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom.
“What we’re seeing is that racial and ethnic discrimination in the U.S. health care system is not uncommon — in fact, it is dramatically more common than in other high-income countries,” said Laurie Zephyrin, M.D., study coauthor and Commonwealth Fund vice president for advancing health equity.
1 in 4 Black and Latinx/Hispanic older adults report racial or ethnic discrimination when seeking health care
Percent of US older adults who report ever feeling that because of their race or ethnicity they have been treated unfairly and/or have not had their concerns taken seriously when receiving health care.
Findings reaffirm earlier studies
- A 2021 analysis of health care spending in the U.S., published in JAMA, found stark disparities across racial and ethnic lines in how medical resources are divided. Non-Hispanic white Americans accounted for 72 percent of the $2.4 trillion spent on ambulatory, inpatient and emergency care, nursing facilities, prescribed pharmaceuticals and dental care in 2016. No other single racial or ethnic group received an outsize piece of the health care pie.
- A 2021 Urban Institute report found Black Americans were nearly three times as likely as whites to have experienced some form of discrimination by a doctor, other health care provider or their staff in the months leading up to and during the COVID-19 pandemic. It estimated that 10.6 percent of Black individuals faced such discrimination based on race, ethnicity, disability, gender, sexual orientation or health condition between September 2019 and September 2020, compared to 3.6 percent of whites and 4.5 percent of Hispanics.
- A 2021 report from the Alzheimer’s Association on “Race, Ethnicity and Alzheimer’s in America” found race and ethnicity are barriers to quality medical care among the 6 million older Americans living with the disease.
What to do?
The report authors suggest that health care organizations should recognize the problem and do their part to address the discrimination found across the system to improve health equity and outcomes for patients of all ages.
“Biases against older people of color are experienced throughout the health care system, and they need to be intentionally rooted out. Health care organizations must be accountable for treating all patients equitably. Policies and practices can help ensure this accountability,” Zephyrin said.
Among some of the report’s recommendations:
- Identify instances of discrimination and publicly report discrimination data. “Older adults of color, particularly those with health concerns, have many interactions with health personnel. Allowing them opportunities to reflect on how they were treated and to report their experiences with discrimination are important steps.”
- Medical students should be taught the history of racism in the health system to better understand their own perceptions of race and implicit biases that could affect their treatment recommendations for patients.
- Promote racial and ethnic diversity in the health system’s workforce.
- Offer translation services and create medical forms in multiple languages for patients who aren’t fluent in English.
Peter Urban is a contributing writer and editor who focuses on health news. Urban spent two decades working as a correspondent in Washington, D.C., for daily newspapers in Connecticut, Massachusetts, Ohio, California and Arkansas, including a stint as Washington bureau chief for the Las Vegas Review-Journal. His freelance work has appeared in Scientific American and on Bloomberg Government and CTNewsJunkie.com.