[Congressional Record Volume 146, Number 154 (Thursday, December 14, 2000)]
[Extensions of Remarks]
[Pages E2186-E2187]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         ELIMINATE RACIAL AND ETHNIC DISPARITIES IN HEALTH CARE

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Thursday, December 14, 2000

  Mr. STARK. Mr. Speaker, Medical Care Research & Review recently 
released a special issue, compiling ten articles from our nation's 
leading researchers in the area of racial and ethnic health 
disparities. Taken altogether, these investigations add to a growing 
body of evidence that leaves little doubt as to the pervasive and 
persistent presence of racial and ethnic disparities in health 
insurance coverage and access to care.
  Many variables are thought to contribute to racial and ethnic 
disparities in health care, such as status of health care coverage and 
income level. Yet across each investigation, regardless of outcome 
measured, racial and ethnic disparities persisted--even when the 
effects of income, health care coverage status, and other individual 
characteristics were controlled.
  As our country continues to diversity, with growing populations of 
African Americans, Latinos, Asians & Pacific Islanders, and Native 
Americans, we, as a nation, must be responsive to the needs of all 
citizens. As reflected in the following findings, this special issue of 
Medical Care Research & Review highlights areas that need to be 
addressed to ensure equitable health care access for everyone.
  People of color are far more likely to lack health care coverage as 
compared to whites, primarily due to lower rates of private health 
insurance coverage, especially employment-based coverage. In 1996, 
people of color comprised only one quarter of the non-elderly 
population, yet they represented 41% of the uninsured.
  The effects of race and ethnicity extend beyond insurance coverage to 
encompass the entire treatment process. For example, the referral 
process for invasive cardiac procedures involves multiple steps and 
decisions. At every step, ranging from the initial recognition of 
symptoms by the patient to obtaining referrals for coronary angioplasty 
or coronary artery bypass surgery, race and ethnicity issues can (and 
often do) enter into the equation.
  Hispanics and African Americans are much more likely to lack a usual 
source of health care and less likely to use ambulatory care as 
compared to whites. The disparities are greatest for Hispanics--for 
whom the probability of lacking a usual resource of care increased from 
19.9% in 1977 to 29.5% in 1996. By way of contrast, this figure 
represents twice the risk faced by whites in 1996.
  Race and ethnicity are also factors in the likelihood of being 
hospitalized for a preventable condition, which is an indicator of 
limited access to primary care. When preventable hospitalizations are 
compared across minority groups and whites, those that fare the worst 
are Hispanic children, African American adults, and Hispanic and 
African American elderly. Even among elderly Medicare beneficiaries, 
all of whom have equal health insurance coverage, the odds of minority 
beneficiaries requiring a preventable hospitalization are 6 to 21% 
greater than for white beneficiaries.
  These many differences are not simply due to unresponsive attitudes 
of a few individual physicians, but the health care delivery system as 
a whole. People of color are twice as likely to say that racism is a 
major problem in health care. Two-thirds of African Americans and more 
than half of Latinos believe they receive lower quality care than 
whites, but most whites believe everyone receives the same quality of 
care. Not surprisingly, those patients who perceive more racism and who 
are more distrustful of the medical system are less satisfied with 
their health care.
  These findings illustrate the importance of delivering culturally 
competent health care at the provider level and throughout the health 
care delivery. One model, presented in this special issue of Medical 
Care Research & Review, illustrates how cultural competency is 
comprised of nine major components, including interpreter services, 
recruitment and retention of bilingual and bicultural health care 
professionals, and the inclusion of family and community members 
throughout treatment. As a result of these techniques, positive changes 
in clinician and patient behavior, such as improved communication, 
increased trust, and expanded understanding of how cultural and 
environmental factors affect patient behavior, can occur. Such positive 
changes can lead to the provision of more appropriate health care 
services and better outcomes--not just in health status but also in 
quality of life, well being, and satisfaction across all ethnic groups.

[[Page E2187]]

  These findings further support the need for eliminating disparities 
that persist in health care and treatment. In order to truly be an 
inclusive society, we must continue to work toward an equitable and 
fair health care system. The Minority Health and Health Disparities 
Research and Education Act (S. 1880), which was signed into law this 
year, along with health disparities provisions in the possible Balanced 
Budget Act relief legislation are two positive steps in that direction. 
I hope we can build on these successes in the upcoming Congress and I 
look forward to working with my colleagues on this important endeavor.