Disparities and discrimination in health care coverage: a critique of the Institute of Medicine study.
The 2003 Institute of Medicine (IOM) study on Unequal Treatment takes the strong position that many of the current disparities in health care by race are attributable to forms of conscious and unconscious discrimination by health care providers. The study, however, is flawed by imprecise definitions of discrimination that fail to distinguish between differences in treatment due to breakdown in communications and differences in the treated population that are prompted by invidious motives of health care providers. It is doubtful that hidden forms of discrimination are prevalent in a profession whose professional norms are set so strongly against it. In addition, the IOM relies too uncritically on similar studies in unrelated fields to show the ostensible forms of discrimination. These errors have adverse social consequences. A false diagnosis of discrimination where none exists will send a false signal to members of racial minorities that may induce them to avoid receiving needed medical care and instead pursue costly and ineffective remedial devices that will take away funds better spent on providing direct health care.
Epstein
Richard A
RA
University of Chicago, 1111 East 60th Street, Chicago, IL 60637, USA. repstein@uchicago.edu
D015982:Bias; D006079:Government Publications as Topic; D005102:Health Expenditures; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D011287:Prejudice; D044469:Racial Groups; D012107:Research Design; D012959:Socioeconomic Factors; D014481:United States