The institutional structures of the health care system are in tension with the goals of providing equal care to minorities.
These structural tensions include the unequal distribution of resources, the fragmentation of the health care system, and the professional and social values of the medical community. The result is that minorities are often treated differently than whites in the delivery of health care and in research.
Differential access to resources is a major cause of minority health issues. In terms of medical care, poor minorities are denied care because they cannot afford it, or they are treated in the emergency room, which is less effective than preventive care.
Fragmentation of the health care system is another source of inequality. Uneven access to health care resources and services results in the need for patients to search for a variety of care facilities. This fragmentation is due, in part, to the demographics of the U.S. population. The population is growing older, and the elderly are more likely to be in need of long–term care. The breakdown of the extended family means that more people need to seek out formal support systems. This has resulted in an increased demand for health care services.
The fragmented health care system has also resulted in an increased demand on the part of health care providers for continuing medical education. To meet this demand, medical facilities are forced to rely on commercial providers for continuing medical education. The commercial providers of continuing medical education have been criticized for having an interest in expanding medical care, and in maximizing profits. As a result, commercial providers may not have the same commitment to social justice that is held by the medical profession.
Another source of fragmentation in the health care system is the recent trend toward for–profit health care. More and more hospitals are becoming for–profit, which means that they have an increased incentive to provide lucrative procedures, and to over–treat patients. For example, in the 1970‘s, hospitals began to provide coronary bypass surgery because of the lucrative nature of the procedure. In a recent study, it was found that black patients were five times more likely to undergo coronary bypass surgery than white patients, even though the two groups were equally likely to have coronary disease. This is an example of over–treatment.
The professional and social values of the medical community have also contributed to power imbalances between minorities and medicine‘s elite professional class. The U.S. medical establishment has historically been dominated by white males. The professional class tends to view itself as superior to those outside its ranks. The medical community has traditionally looked down on minorities and the poor.
The medical community is also known to be judgmental of those who do not follow its norms, and of those who do not follow the “standard of care,” which may be of lesser quality than alternative treatments. The professional, social values of medicine‘s elite professional class have also led to a rigid hierarchical structure within the medical community. Medical professionals are socialized to believe that their knowledge and expertise are superior to that of patients and the public, and that they have the right to make decisions on their behalf.
The structural nature of the health care system, along with the professional and social values of the medical community, contribute to the disparities in health care that exist between minorities and whites in the U.S. These disparities are contributing to the increasing gap in life expectancy between the rich and the poor in the U.S., so it is of paramount important that we address these issues.