Racial disparities in care: the concealed legacy of a divided system.
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.
Smith
David Barton
DB
Department of Risk, Insurance and Healthcare Management, Fox School of Business and Management, Temple University, Philadelphia, Pennsylvania 19122, USA. dbsmith2@comcast.net
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