One-Quarter of Adults Report Racial Discrimination in Healthcare

Two years after the medical industry joined the rest of the nation in a racial reckoning, patients are still reporting a healthcare experience characterized by racial discrimination, according to data shared with PatientEngagementHIT via email.

In a new report from The Commonwealth Fund, one in four Black and Hispanic adults over age 60 said they’ve experienced racial discrimination in healthcare. Those people told researchers their clinicians treated them unfairly or did not take their symptoms seriously because of their race.

Of those who reported previous experiences of discrimination, 27 percent said they did not get the care that they needed because of it.

Racial discrimination can have critical health impacts, the researchers said. Weathering, or the idea that a person’s mental and physical health can decline because of the discrimination they face across a lifetime, is starting to show itself in some clinical data. People of color, particularly Black people, can see higher blood pressure, worse mental health, and early aging due to racial discrimination.

The healthcare setting is not immune to this kind of implicit or explicit bias. According to The Commonwealth Fund researchers, discrimination in healthcare might mean a provider dismisses patient symptoms, doesn’t get a medical interpreter to deliver care in a patient’s preferred language, or offers different treatment based on insurance type.

Black people were most likely to report racial discrimination in a healthcare setting, with 44 percent of all Black people reporting this happens often or very often, regardless of gender. Twenty-seven percent of Hispanic people reported discrimination in healthcare; interestingly, that is a smaller proportion than White people reporting the same (31 percent).

When looking at individuals who have reported any instance of healthcare discrimination, the share of White people reporting went down drastically. Only 3 percent of White people said they’ve ever been discriminated against due to race. Conversely, 23 percent of Latinx and 25 percent of Black people reported as much.

Across all races, women were more likely than men to report racial discrimination in healthcare, potentially because women face their own struggles when receiving medical care.

Of those who said they’ve ever experienced racial discrimination in healthcare, 27 percent said they didn’t end up getting the care they needed.

“Previous research on older adults of color found that perceived discrimination was associated with an increased risk of avoiding or delaying care, in part because doctors may communicate messages that discourage appropriate use of health services,” the Commonwealth Fund researchers posited.

That’s a significant problem, the data furthered, because folks experiencing discrimination are also those most likely to face complex health and social determinants of health needs. A whopping 75 percent of those reporting discrimination also say they are high-need, while 48 percent said they are in fair or poor health. Forty-two percent reported low patient satisfaction, 39 percent reported a mental health diagnosis, 32 percent said they have a material hardship, and 25 percent said they’ve experienced social isolation.

Far fewer of folks not reporting experiences of discrimination said they face these problems. The biggest issue at play was reports of being high-need, with 48 percent of those never facing discrimination reporting as much. Still, that is dwarfed by the number of folks experiencing discrimination who are also high-need, the data showed.

Moreover, reports of racial discrimination in the US far outpace reports in other similarly developed nations. While racial discrimination is not a uniquely American problem, it is significantly more prominent in the US healthcare system.

Thirty-two percent of Americans agreed the US healthcare system treats people differently based on their race or ethnicity. The US is trailed by Canada, where only 17 percent of people agreed discrimination is a problem in healthcare. People in Switzerland, the UK, and Norway were far less likely to report problems of racial discrimination, with only 4, 5, and 5 percent of people reporting such, respectively.

Of course, those numbers only reflect patient reports and perceptions. They do not reflect actual reports of discriminatory practice, so racial discrimination could be more common in those other nations that people perceive.

Nevertheless, the Commonwealth Fund researchers recommended the US develop a better reporting and accountability system for racial discrimination in healthcare. Standardized patient satisfaction surveys should begin asking patients about incidents of explicit or implicit bias.

Online provider reviews, an informal version of patient experience measurement, are already proving effective channels for measuring racial discrimination, which could prove the utility of codifying measures in traditional surveys.

Additionally, medical education and training should emphasize the role of race and racism in America, and how historical injustice has shaped the current healthcare industry. Cultural humility and responsiveness may help healthcare providers recognize their own implicit biases and strengthen their relationship-building skills.

Finally, the Commonwealth Fund researchers suggested the medical industry focus on diversifying its workforce. Studies have shown patient experiences and outcomes can improve when they visit with a provider of the same race or ethnicity. Additionally, a diverse workforce can help bring a multicultural perspective to the profession and spark long-term institutional change.