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Gwendolyn Roberts Majette

From: Gwendolyn Roberts Majette, Access to Health Care: What a Difference Shades of Color Make, 12 Annals of Health Law 121 (2003) (114 Footnotes Omitted)

      In 1999, Congress provided funding to the Office of Minority Health “for a one-time Institute of Medicine study of the prevalence and impact of ethnic bias in medicine.” On March 20, 2002, the Institute of Medicine reported its findings. The report attracted worldwide attention and confirmed what minority communities have known for years: that race and ethnicity affect access to, and the quality of, health care received. Prognostications of these findings existed in 1999 when the New England Journal of Medicine published a study designed specifically to evaluate the effect of a patient's race and sex on the physician's recommendation for cardiac catheterization. The study concluded that race and sex are important, independent factors that influence how physicians manage chest pain.

      Access to health care encompasses at least four aspects of health care coverage: affordability, availability, usability, and acceptability.   More simply, access is entry into the health care system.  Gaining access is difficult for people of color because the United States health care system is based on a white male paradigm.  This paradigm explicitly highlights race, ethnicity and sex, and implicitly economic status, due to the dominance of white males in employment positions of power and high compensation.

      This article outlines some of the major issues that affect access to health  care for various minority communities, focusing on barriers to access for four distinct racial/ethnic groups: African Americans, Asian Americans, Hispanic Americans, and Native Americans.  This comparative analysis shows that race, ethnicity, and sex affect whether one receives health care, as well as the quality of health care received.  The only difference among the various ethnic groups is how the adverse effect manifests itself.

      Part I outlines two key factors affecting access to care - race and ethnicity - and defines access to care.  Part II defines the barriers to access of health care and discusses some of the previously unsuccessful legal solutions and remedies.  Part III outlines how practitioners in various disciplines can combine their knowledge to develop a strategy that will end the use of a patient's race and ethnicity as a determinative factor in one's receipt of quality health care.