1 in 5 Patients Report Discrimination in Healthcare Experiences

Twenty-one percent of patients said their healthcare experiences have been marked by some sort of discrimination, with just about three-quarters of those discriminatory experiences having something to do with race or ethnicity, according to a new study published in JAMA Network Open.

These findings come as the medical industry joins a national reckoning around race and racism. In the wake of the stark racial health disparities related to COVID-19 infections and deaths, as well as the resurgence of the Black Lives Matter movement, the healthcare industry has looked inward and how various stakeholders experience racism and other forms of discrimination.

“Health systems in the US are increasingly expressing concern about understanding and responding to social determinants of health,” which can include race and racism, the researchers explained.

“Daily experiences of discrimination in other contexts (eg, while shopping, in employment, or in housing) have been studied extensively in association with downstream health outcomes, including but not limited to hypertension, cardiovascular disease, poor sleep, mental health symptoms, lower trust in the health care system, delayed or avoided care, and underuse of mental health services.”

This latest study looked at patient experiences of discrimination in the medical setting in isolation, finding that these instances are relatively common.

In an analysis of just over 2,100 responses to the 2019 National Opinion Center’s AmeriSpeak survey, the team determined that about one in five, or 21 percent, of patients have experienced some form of discrimination during a healthcare encounter. Most of those reporting experiences of discrimination reported experiencing it more than once, the team added.

Most of the reports about discrimination related to race or ethnicity, but patients also said they had faced discrimination about their educational or income level, weight, sex, and age, the researchers said.

Patients who were female, younger, and earned less than $50,000 annually were more likely to report discrimination in healthcare than others, the surveys showed. Additionally, individuals reporting fair or poor health were more likely to report discriminatory experiences than those reporting better health.

There is a chance patient experiences of discrimination are more expansive than the study could detect, the researchers added.

“Patient self-reports of discrimination are challenging to measure because the specific types of discrimination occurring may be unclear,” the research team wrote. “This survey was able to capture only a single type of discrimination, which may mean that the reports underestimated patient experiences of discrimination.”

What’s more, discrimination may become internalized, meaning the patient does not detect it, which may also further underestimate the prevalence of discrimination in healthcare.

These experiences of discrimination could have negative consequences on patient health or outcomes, the researchers said. Patients who experience discrimination in the medical setting may lose trust in their providers, not communicate openly, or opt out of seeking healthcare altogether.

Trust is essential to a good-patient provider relationship considering the extremely personal nature of healthcare, and discrimination can cause significant damage to that trust.

These findings come as healthcare joins in the national reckoning with race and racism, born out of both COVID-19 racial health inequities and the Black Lives Matter movement. In addition to participating in that movement, individual healthcare organizations can take their own steps to mitigate the harms of discrimination on a micro-scale. For example, organizations may add questions about experiences with racism or discrimination on patient experience and satisfaction surveying.

Organizations should look at their patient populations and national patient needs to determine what types of surveying questions may be applicable to them. Questions about racial, weight, income, or education level bias may be pertinent, as well as questions about prescription drug use or pain management, the researchers advised.

Experiences of discrimination could have adverse health consequences beyond damaging the patient-provider relationship and patient access to care, separate research has found. In July 2020, the American Heart Association (AHA) unveiled data showing that the stress of experiencing discrimination in and out of the healthcare setting could increase a patient’s odds of developing high blood pressure.

Black patients in Mississippi who experienced at least moderate discrimination across their lifetimes were more likely to develop high blood pressure than those who did not, the AHA team found. These findings align with observed racial health disparities. Black patients are more likely than White patients to have high blood pressure, the researchers said.

“Our findings highlight the need for health care professionals to recognize discrimination as a social determinant of health,” said Allana T. Forde, PhD, MPH, the study’s first author and a postdoctoral research fellow at the Urban Health Collaborative at Drexel University. “Health care professionals who understand the importance of unique stressors like discrimination that impact the health of African Americans will be better equipped to provide optimal patient care to this population.”