Poor patients perceive discrimination in care

Poor, uninsured people report disrespect, racial discrimination, or other unfair treatment during health care visits, according to a recent study.

University of South Carolina sociology professor Irena Stepanikova, PhD, and a colleague evaluated data on 4,556 U.S. adults who participated in a telephone survey in which they reported whether they had experienced disrespect or unfair treatment during a health care visit because of their racial or ethnic background.

Responses by uninsured blacks, Hispanics, and poor whites indicate that "uninsurance and poverty are related to increased perceptions of racial and ethnic bias in health care," says Stepanikova. She and her co-author wrote that discrimination in health care poses a significant public health problem, because people who have experienced it are more likely to put off medical tests and procedures and less likely to receive preventive health care services, such as flu shots and cholesterol testing.

Overall, people without insurance had 2.39 times higher odds of perceiving racial and ethnic bias during health care visits, compared to people with private insurance. Those living below the poverty line also were more likely to report feeling discriminated against, the authors report.

Among the most common factors leading to the patients' perceptions of biased treatment include: clinical staff "talking down" to the patient, other patients seen ahead of the surveyed patient, clinician didn't pay enough attention or spend enough time, and health care providers didn't take time to clearly explain things.

"Unfortunately, stereotyping and bias are more likely in situations in which providers are stressed and under time pressure — attributes that may disproportionately afflict settings where minorities and the uninsured get care," reports Burgess.

(To read the full report, go to: Stepanikova I, Cook KS. The effects of poverty and lack of insurance on perceptions of racial and ethnic bias in health care. Health Services Research on-line, 2007; www.blackwell-synergy.com/loi/hesr.)