Disparities and Discrimination in Health Care Coverage: A Critique of the Institute of Medicine Study
41 Pages Posted: 29 Apr 2004
Date Written: March 2004
Abstract
The constant condemnation of discrimination in the access to health care in the United States suffers from a number of flaws. First, by refusing to offer any explicit definition of discrimination, it fails to distinguish between differential treatment that is attributable to bias or prejudice from that which counts a rational response to differences in patient need. Discrimination based on cost-differences will not be, and should not be expected to be, eliminated by market forces, while those which are not will be, and should be, eliminated. Second, it relies improperly on studies that purport to find discrimination in other markets. Third, the evidence of discrimination in health care often ignores problems in communication, and differences in family and social structure that could lead conscientious physicians properly to use different approaches for patients of different races. With the striking absence of any overt evidence of discrimination, investigators should be cautious about inferring discrimination from statistical studies that are at best able to control for a small fraction of the relevant variables.
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