Chapters

SUMMARY
1-28

1 INTRODUCTION AND LITERATURE REVIEW
29-79

2 THE HEALTHCARE ENVIRONMENT AND IT’S RELATION TO DISPARITIES
80-124

3 ASSESSING POTENTIAL SOURCES OF RACIAL AND ETHNIC DISPARITIES IN CARE: PATIENT & SYSTEM LEVEL FACTORS
125-159

4 ASSESSING POTENTIAL SOURCES OF RACIAL AND ETHNIC DISPARITIES IN CARE: THE CLINICAL ENCOUNTER
160-179

5 INTERVENTIONS: SYSTEMIC STRATEGIES
180-198

6 INTERVENTIONS: CROSS-CULTURAL EDUCATION IN THE HEALTH PROFESSIONS
199-214

7 DATA COLLECTION AND MONITORING
215-234

8 NEEDED RESEARCH
235-243

REFERENCES
244-268
269-270

APPENDICES
271-284
285-383
384-391
392-405
406-414
415-416

PAPER CONTRIBUTIONS
417-454
455-527

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Racial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities, even when access-related factors, such as patients’ insurance status and income, are controlled. The sources of these disparities are complex, are rooted in historic and contemporary inequities, and involve many participants at several levels, including health systems, their administrative and bureaucratic processes, utilization managers, healthcare professionals, and patients. Consistent with the charge, the study committee focused part of its analysis on the clinical encounter itself, and found evidence that stereotyping, biases, and uncertainty on the part of healthcare providers can all contribute to unequal treatment. The conditions in which many clinical encounters take place—characterized by high time pressure, cognitive complexity, and pressures for costcontainment—may enhance the likelihood that these processes will result in care poorly matched to minority patients’ needs. Minorities may experience a range of other barriers to accessing care, even when insured at the same level as whites, including barriers of language, geography, and cultural familiarity. Further, financial and institutional arrangements of health systems, as well as the legal, regulatory, and policy environment in which they operate, may have disparate and negative effects on minorities’ ability to attain quality care.