Discrimination in Healthcare Affects Patient Experience, Outcomes

More data is out demonstrating the role racism and discrimination play in healthcare, with the latest from KFF showing that Black, Hispanic, American Indian/Alaska Native (AI/AN), and Asian people are more likely to report unfair treatment in healthcare than their White counterparts.

Overall, 18 percent of Black people, 11 percent of Hispanic people, 12 percent of AI/AN people, and 10 percent of Asian people said they were treated unfairly or disrespected by a healthcare provider due to their race in the past three years. This compares to just 3 percent of White people who said the same.

Discrimination and racism in healthcare is an increasingly explored topic as experts continue to unwind racial health disparities that have segregated outcomes on racial and other demographic lines. Institutional, implicit, and explicit racism has led to poorer health outcomes for some populations—redlining leading to racial and geographic health disparities, for example—while other surveys have looked at the role of implicit and explicit bias in the clinic or exam room.

This most recent KFF report adds to both by examining experiences of racism and discrimination in everyday life, plus reports of racism inside the healthcare setting.

As noted above, racial and ethnic minorities are more likely to report experiences of racism or unfair treatment from a healthcare provider, with Black women being the most likely subgroup to report unfair treatment.

Types of unfair treatment include having a provider assume something about them without asking, indicating that the patient is to blame for a health condition, ignoring a direct request or question, or refusing to prescribe pain medication the patient thought they needed.

Around a quarter of Black adults said they faced one of these conflicts within the past three years, while 19 percent of AI/AN patients, 15 percent of Hispanic people, and 11 percent of Asian adults said the same. That’s compared to 4 percent of White patients who reported such behaviors.

Instances of racism and discrimination are ultimately shaping the way patients of color experience the healthcare system.

For example, many racial and ethnic minorities prepare for racist encounters even before heading into the clinic or hospital, with some saying they even prepare their physical appearance to increase the odds they’ll be treated fairly. Six in 10 Black adults, 52 percent of AI/AN adults, 51 percent of Hispanic adults, and 42 percent of Asian adults said they do this.

What’s more, experiences of racism and discrimination in the healthcare setting influence healthcare access. Patients who reported negative experiences with healthcare providers said they faced worse health, were less likely to see care, or switched providers. This was more common among AI/AN and Black adults than White adults who had bad healthcare experiences.

It’s not just racism in the exam room that’s influencing patient health, the survey furthered.

Experiences of racism, even outside the healthcare setting, are showing to affect health outcomes. Overall, around half of AI/AN, Black, and Hispanic adults and about four in 10 Asian adults said they’ve experienced racism or discrimination in daily life at least a few times in the past year.

And folks who reported racism and discrimination in daily life are more likely to say they face adverse impacts from worry and stress, loneliness, and anxiety or depression from it, compared to those who face less discrimination.

For example, 65 percent of those reporting racism in daily life said their stress leads to sleep problems, compared to just 35 percent of those facing less regular racism who said the same.

Similar trends emerged when looking at stress-related poor appetite or overeating (52 percent versus 20 percent), frequent headaches or stomach aches (41 percent versus 15 percent), worsening of chronic conditions (19 percent versus 9 percent), or increase in substance use (19 percent versus 6 percent).

These findings give credence to the weathering hypothesis, which states that the chronic stress incurred from facing regular racism and discrimination can have an impact on one’s physical and mental health.

There are some solutions that are within the control of the healthcare sector. Visiting with a provider with a shared background and racial concordance increased the odds of a positive and respectful patient-provider interaction, the survey showed.

However, racial concordance doesn’t happen very often, with racial and ethnic minorities saying they experience racial concordance with their providers less than half the time. Ongoing efforts to increase workforce diversity, particularly by increasing diversity in medical education, are necessary.

But while the healthcare industry, facing an increasing staffing crisis, continues to see a Whiter workforce, it will also be prudent to prioritize cultural competence and responsiveness.