Health Disparities in the U.S.: Part 4

As I explained in part one of this series of posts, minority racial and ethnic groups in the United States experience widespread and severe disparities in healthcare. Over the last few years, I have dedicated my time to researching health and treatment disparities in America that affect racial minorities. The COVID-19 pandemic has only exaggerated the issues, and I therefore feel that it is prudent to explore some of my research in multiple posts.

In my previous post, I began to delve into interpersonal barriers to equal healthcare. While structural barriers play a significant role in the decision to seek treatment, it is possible that interpersonal barriers may moderate the relationship between structural barriers and healthcare seeking behavior (Burgess et al., 2018; Betancourt et al., 2003; Mkandawire-Valhmu, 2018). For instance, after the state of Massachusetts implemented healthcare reform to decrease rates of uninsurance among racial and ethnic minorities, researchers found that the logistical reform alone was insufficient in decreasing health disparities; efforts beyond greater insurance coverage would be necessary to create real, lasting change (McCormick et al., 2015). Research on interpersonal barriers to healthcare has focused on factors (e.g. trust, representation, and cultural competence) affecting the quality of the physician-patient relationship. A good physician-patient relationship makes patients more likely to seek healthcare–leading to the idea that interpersonal factors may moderate the relationship between structural barriers and healthcare seeking.

Given the low levels of representation of racial minority groups in healthcare settings, some researchers have investigated the role of racial bias or lack of cultural competence among medical professionals. Cultural competence is “the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients” (Betancourt et al., 2003). In the 2008 National Healthcare Disparities Report, Black Americans reported significantly lower quality of care than White Americans on 19 of 38 measures and poorer physician-patient communication than White patients (American College of Physicians, 2010). Racial discrimination and the resulting unequal treatment decreases care seeking behavior, regardless of SES and insurance. Furthermore, a study by Obermeyer et al. (2019) investigated an algorithm widely used in US hospitals to allocate healthcare to patients. The algorithm was found to assign Black patients at the same sickness level as their White counterparts lower health risk scores. Obermeyer et al. (2019) found that should an unbiased algorithm be used, the percentage of Black patients referred for care would increase from 17.7% to 46.5%. It is clear that interpersonal variables can moderate the relationship between structural barriers and care seeking in either direction.

In summary, health disparities affecting those of racial and ethnic minorities in the US are a result of widespread and systemic issues. The problems behind unequal treatment and lack of utilization of treatment can be split into logistical and interpersonal categories. The logistical side refers to insurance, socioeconomic status, and social determinants of health, whereas the interpersonal aspects involve trust and cultural competence. Understanding the relationship between these variables is important in order to increase healthcare utilization.

Despite the large number of studies investigating the role of structural versus interpersonal barriers to accessing healthcare, few studies have investigated the complex relationship between the two types of barriers. It is possible that while logistical barriers are the major limiting factor in a decision of whether or not to seek treatment, interpersonal aspects have a significant moderating effect in that decision.

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