title: Racial disparities in care: the concealed legacy of a divided system.
abstract: OBJECTIVE
  New national initiatives to end racial disparities in health could benefit from the experience with Title VI enforcement in the Medicare Program.
  
  
  OBJECTIVE
  The goals of this study were to describe events in a test case to extend Medicare Title VI conditions for hospitals to the practice patterns of its medical staff and how the outcome shaped disparities.
  
  
  METHODS
  This article distills interviews, archives, and secondary data sources.
  
  
  METHODS
  This study is an historical narrative.
  
  
  RESULTS
  The test case was a costly failure. Although the Title VI effort eliminated segregation on hospital floors and equalized overall use, physician practice patterns were left unexamined, contributing to the persistence of disparities in treatment.
  
  
  CONCLUSIONS
  If current efforts are to be successful, they will need to 1) address the structural issues that shape disparities, 2) pay particular attention to reengineering care in ways that overcome historic patterns, and 3) ensure a greater degree of accountability.
authors.affiliation: Department of Risk, Insurance and Healthcare Management, Fox School of Business and Management, Temple University, Philadelphia, Pennsylvania 19122, USA. dbsmith2@comcast.net
authors.forename: David Barton
authors.initials: DB
authors.lastname: Smith
mesh_terms: D000407:Alabama; D002961:Civil Rights / Q000266:history / Q000331:legislation & jurisprudence*; D019983:Guideline Adherence; D006297:Health Services Accessibility; D049673:History, 20th Century; D006761:Hospitals / Q000266:history / Q000706:statistics & numerical data; D006801:Humans; D006278:Medicare / Q000266:history / Q000331:legislation & jurisprudence*; D008913:Minority Groups; D010343:Patient Admission / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000266:history / Q000706:statistics & numerical data; D011287:Prejudice; D012749:Sexually Transmitted Diseases / Q000208:ethnology / Q000517:prevention & control*; D014342:Truth Disclosure