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OCR for page 739
Index
A
AAHP. See American Association of Health
Plans
AAMC. See Association of American
Medical Colleges
AAPI. See Asian Americans and Pacific
Islanders
AAPIHF. See Asian American and Pacific
Islander Health Forum
Aboriginal people (Australia), 441
Access
to data sources, 229
to medical treatment, 645-647
to services, 143-144
Acculturation, defined, 464, 475, 521
Acute myocardial infarction (AMI), 44, 46,
426-428, 431
Administrative choices
in the design of managed care systems,
691-693
in establishing conditions of
participation and quality of care
management, 690-691
in separate SCHIP programs, 689-690
African Americans, 2, 34, 84-85, 278, 475-
477. See also Blacks
defined, 32n, 34
and the "over-diagnosis" of
schizophrenia, 612-613
739
African Moors, 498
Agassiz, Louis, 501
Age-adjusted death rates
for all causes of death by race and
Hispanic origin, 82
for selected causes of death by race and
Hispanic origin, 83
Agency for Healthcare Research and
Quality (AHRQJ, 219, 223, 226,
235, 243, 386, 420, 659, 711
Assessment of Quality Improvement
Strategies in Health Care, 386
Measures of Quality of Care for
Vulnerable Populations, 386
Translating Research into Practice, 386
Understanding and Eliminating
Minority Health Disparities
Initiative, 386
AHRQ. See Agency for Healthcare
Research and Quality
Alaska Native Colorectal Cancer Education
Project, 387
Alaska Native Tribal Health Consortium,
534n
Alaska Natives, 34, 85, 89, 477-478
defined, 34, 522
Albert Einstein School of Medicine, 634
Alexander v. Sandoval, 158, 641-642, 656, 661-
662, 693n
Alien, Sedition, and Naturalization Acts, 459
OCR for page 740
740
AMA. See American Medical Association
American Association of Health Plans
(AAHP), 218
American College of Surgeons, 108
American Health Dilemma, An, 489
American Indian and Alaskan Native
Planning Grants, 391
American Indians, 34, 85, 89, 477478
defined, 34, 474, 522
American Medical Association (AMA), 107-
108, 273, 419, 503, 505, 507, 659
Council on Medical Education, 107
American Nursing Association, 203
American Public Health Association, 609
American racial and ethnic relations, 458-
460
AMI. See Acute myocardial infarction
Amputations, 74
Analgesia, 64-66, 290-295
Analgesic medication, 326-327
differential levels of prescription of, 11
Ancient origins, 497498
Angina, 165
Angiography and angioplasty, 137, 427, 434
Anglo-Protestants, 471, 483
defined, 522
Anglo-Saxon, defined, 522
Antebellum period, 471, 501
Anti-discrimination thesis, 722
Anti-Semitism, 486
API. See Asian Americans and Pacific
Islanders
Archaic medical system, 498
defined, 522
Argon laser trabeculoplasty surgery, 71
Aristotle, 497498
Art of Care Scale, 613
Asian American and Pacific Islander
Health Forum (AAPIHF), 284
Asian Americans and Pacific Islanders
(API), 34, 85-86, 89-90, 478-480
defined, 34, 474, 522
Assessment of Quality Improvement
Strategies in Health Care, 386
Assimilation, 475, 522
identificational, 523
Association of American Medical Colleges
(AAMC), 121, 421
Assumptions about racial and ethnic
disparities in healthcare, 3-4, 30-
35
INDEX
Asthma, 62-63, 296-297
Attitude of healthcare providers, 400401
Australian Aboriginal, defined, 474
Availability of services, 143-144
Aversive racism, 494, 614-616
Awareness of racial and ethnic differences
in healthcare
increasing among healthcare providers,
6, 20, 124
increasing among the general public and
key stakeholders, 6, 20,124
AZT medication, 436
B
Bakke decision, 121
Balanced Budget Act of 1997, 683, 689n
Barriers for immigrants, 660
Bayer Institute, 196
Bayesian physicians, 167-168
Becker, Howard, 599
2002 Behavior Risk Factor Surveillance
System, 387-388
Bernier, Franc5Ois, 499
BIA. See Bureau of Indian Affairs
Bias
defined, 522
of efficacy, 603-604
in physician decision-making, 632-637
in social stereotypes and attitudes, 169-
171
Bill of Rights, 459
Biological differences, that may justify
differences in receipt of care, 138-
139
Biometric testing, 504
Blacks, 34, 475477. See also African
Americans
defined, 32n, 34, 474, 522
Blumenbach, Johann Fredreich, 500
Boren Amendment, 675n
Boys in White, 599
British Medical Journal, 441
Brown v. Board of Education, 107
Buffon, George-Louis Leclerc, 500
Bureau of Indian Affairs (BIA), 462, 488,
531-532
Bureau of Justice Statistics, 654
Bureau of Primary Health Care, 389
Quality Center, 389
Bureau of Prisons, 530
OCR for page 741
INDEX
Bureau of the Census. See U.S. Census
Bureau
Bystanders as interpreters, 143
C
CABG. See Coronary artery bypass graft
CAMPS. See Consumer Assessment of
Health Plans; Consumer
Assessment of Health Plans
Survey
California Children and Families
Commission, 226
California Civil Rights Initiative, 122
California Department of Health Services,
225-226
California Endowment, 226
California Health Interview Survey (CHIS),
225-226
California Healthcare Interpreters
Association (CHIA), 193
California Public Employees Retirement
System (CalPERS), 699n
California Regents decision, 122
Calman, Neil, 634
CalPERS. See California Public Employees
Retirement System
Cambodian language, 89
Cambridge Health Alliance, 391
Camper, Petrus, 500
Cancer, 52-57, 298-305, 431433
racial and ethnic differences in, 5
CAP. See Community Access Program
Capitation, and DRGs, 713-715
Carcinoembryonic antigen (CEA) testing, 54
Cardiac medication, 30
Cardiopulmonary resuscitation (CPR), 71
Cardiovascular care, racial and ethnic
differences in, 5
Cardiovascular disease, 39, 42-52, 306-325,
328-329
studies of the role of financial and
institutional characteristics, 45-48
studies to assess appropriateness of
services, 48-49
studies using administrative databases,
4245
Carter, Michael, 646, 663
CASS. See Coronary Artery Surgery Study
Catastrophic Health Emergency Funds
(CHEF), 541-542, 549
741
Catheterization, 135, 163
Causality, social structural egalitarian
views of, 732-734
Cautions, about health systems issues and
the complexities of mental health
phenomena, 618-619
CCHCP. See Cross Cultural Health Care
Program
CD-ROM-based instructional material, 18,
196-197, 387
CDC. See Centers for Disease Control and
Prevention
CEA. See Carcinoembryonic antigen testing
Centers for Disease Control and Prevention
(CDC), 226, 243, 385-388
Alaska Native Colorectal Cancer
Education Project, 387
2002 Behavior Risk Factor Surveillance
System, 387-388
Hispanic Colorectal Cancer Outreach
and Education Project, 387
National Breast and Cervical Cancer
Early Detection Program
(NBCCEDP), 387
National Comprehensive Cancer Control
(CCC) Program, 387
National Program of Cancer Registries,
387
National Training Center, 387
prostate cancer screening behaviors, 387
Racial and Ethnic Approaches to
Community Health, 386-387
Centers for Medicare and Medicaid
Services (CMS), 222, 224, 388
Excellence Centers to Eliminate Ethnic /
Racial Disparities, 388
Reducing Health Care Disparities
National Project, 388
Centers of Excellence, 386, 391
Cerebrovascular disease, 57-58, 328-331
Cesarean deliveries, 67
Changes
in concepts of race and ethnicity, 490496
in the ethnicity and race of medical
students, physicians, nurses, and
healthcare staff, 621
in the healthcare arena, 534-535
CHCs. See Community health centers
CHEF. See Catastrophic Health Emergency
Funds
Chen, Jersey, 633
OCR for page 742
742
CHF. See Congestive heart failure
CHIA. See California Healthcare
Interpreters Association
Children's health services, 68-69, 330-335
Chinese Americans, 93-94
Chinese Exclusion Act, 459
Chinese language, 89
CHIS. See California Health Interview
Survey
CHS. See Contract Health Service
Cincinnati Children's Hospital Center, 197
Civil Rights Act, 157, 188, 221, 507, 628-631,
668, 679
Title VI, 157, 159, 188, 192, 221, 628-631,
637-641, 668, 679
Title VII, 631
Civil rights dimension of racial and ethnic
disparities in healthcare, 626-663
defining discrimination, 629-632
discrimination as a root cause of
disparities, 632-649
using civil rights strategies to assist in
eliminating racial and ethnic
disparities, 649-663
Civil Rights Division, 654
Civil rights enforcement, 15, 187-188
Civil Rights era in healthcare, 506
Civil Rights Movements, 505
Civil rights strategies
developing a comprehensive language
access agenda, 657-660
developing capacity and infrastructure
to address critical civil rights
questions in managed care, 662
fixing the Sandoval decision, 661-662
identifying and eliminating other
barriers for immigrants, 660
mandating the collection of data on race,
ethnicity, and language of
preference, 650-655
performing a civil rights self-assessment,
662-663
preventing discrimination through
education of providers and
patients, 660-661
strengthening the federal, state, and
private healthcare, 655-657
using to assist in eliminating racial and
ethnic disparities, 649-663
Civil War, 471, 501-502
discrimination during, 103
INDEX
CLAS. See Culturally and linguistically
appropriate services, standards
for healthcare
Class, defined, 522
Clinical caretakers as discretionary actors,
128-130
Clinical decision-making and the roles of
stereotyping, uncertainty, and
bias, 236-237
Clinical discretion, 125-130
clinical caretakers as discretionary
actors, 128-130
patient as discretionary actor, 128
subjectivity and uncertainty, 128-130
subjectivity and variability, 128
utilization managers as discretionary
actors, 130
Clinical encounters, 160-179
healthcare provider prejudice or bias,
162-174
medical decisions under time pressure
with limited information, 161-162
mistrust and refusal, 174-175
patient response, 174-175
Clinical uncertainty, 9, 167-169
Clinician "bias," 611-616
Clinton, William, 626, 677, 692, 705
"Closing the Health Gap" campaign, 123
CMS. See Centers for Medicare and
Medicaid Services
Cobb, W. Montague, 505
COGME Reports, 118, 120
Cognitive shortcuts, in physician decision-
making, 11, 160-161
Cold War, 506
Collecting data on healthcare access and
utilization, by patient race,
ethnicity, socioeconomic status,
and primary language, 21-22, 233
Colonial period, 501
Columbus, 465
Commercial capitalism and the slave
society, 466467
Commissioned papers, 273
Commonwealth Fund, 219, 226, 421, 574
Communication and clinical decision-
making, sociocultural differences
between patient and provider
influencing, 214
Communication style, patient satisfaction
and health outcomes, 574-575
OCR for page 743
INDEX
Community Access Program (CAP), 388-389
Community Action Grant Program, 390
Community and Migrant Health Centers
Program, 112
Community health centers (CHCs), 112,
114, 506
743
impact on racial and ethnic disparities in
healthcare, 699-721
managed competition, 705-706
racial and ethnic disparities, 706
supply-side approaches, 703-705, 712-718
Cowan v. Myers, 678n
impact on healthcare in minority and
medically underserved areas, 112,
114
Community Health Representatives, 548
Community health workers, 17-18, 21, 193-
195
increasing racial and ethnic minorities'
access to healthcare, 195
Compacting, improvement in quality of
care, 543-545
Competitive racism, 493
Concentration of poverty, in 100 largest
U.S. cities, 688
Concepts of race and ethnicity, 490496
on ethnic groups, 495496
on racial groups and hierarchies, 490-493
racial models as tools for analysis and
understanding, 493-495
Congestive heart failure (CHF), 72
Constructionist thinking, 496
defined, 522
Consumer Assessment of Health Plans
Survey (CAMPS), 69, 223, 711
Consumer information, 711-712
Consumer Perspective, Clinical Guidelines
for Providers, and Provider and
System Competencies for
Training, 390
Contract Health Service (CHS), 536, 539,
541-543, 549
Contracting, improvement in quality of
care, 543-545
Control, over key clinical characteristics,
380-383
Cook v. Ochsner Foundation Hospital et al.,
682n
Cooper-Patrick, Lisa, 635
Coronary artery bypass graft (CABG), 30,
4349, 137-140, 149-150, 425, 427-
430
Coronary artery disease, 425-431
Coronary Artery Surgery Study (CASS), 419
Cost containment strategies, 700-706
demand-side approaches, 701-702, 706-
712
(61~1~. see (cardiopulmonary resuscitation
Criminal justice, racial discrimination in,
100-101
Criteria for literature review, 4041
ranking of studies, 41
review papers, 41
search keywords, 40
"threshold" criteria, 40
Critical analysis of the culture of medicine,
620-621
Cross-cultural approach, 206-207
Cross-cultural communication, links to
racial/ethnic disparities in
healthcare, 200-201
Cross-cultural curricula, in undergraduate
medical education, 202
Cross-cultural education
challenges and opportunities, 211-212
cultural sensitivity/awareness approach,
203-204
developing the field, 211
evaluation, 209-211
focus on attitudes, 203-204
focus on knowledge, 204-206
focus on skills, 206-207
foundation and emergence of, 201-203
in the health professions, 19-20, 199-214
improving healthcare professionals'
ability to provide quality care, 214
multicultural/categorical approach, 204-
206
provider perspectives, 211
teaching methods and opportunities,
207-209
in the training of health professionals,
214
Cross Cultural Health Care Program
(CCHCP), 385
Cuban Americans, 87
Cultural sensitivity/awareness approach,
203-204
Culturally and linguistically appropriate
services (CLAS), standards for
healthcare, 181-183, 192
OCR for page 744
744
Culturally appropriate patient education
programs, increasing patients'
knowledge of accessing care and
participating in treatment
decisions, 198
Culture
defined, 522
expression of mental illness, 614
"Culture, Communication, and Health"
course, 209
Culture of medicine, 594-625
addressing healthcare disparities
through the training of healthcare
professionals, 606-611
African Americans and the "over-
diagnosis" of schizophrenia, 612-
613
bias of efficacy, 603-604
case analyses of disparities in mental
health services, 611-612
cautions about health systems issues and
the complexities of mental health
phenomena, 618-619
"clinician bias," "aversive racism," and
misdiagnosis, 614-616
culture and the expression of mental
illness, 614
disruptions in the medical machine, 600-
603
insights from physicians in academic
teaching hospitals, 598-600
needed research, 619-621
political correctness, the medical
machine and the meaning of bias
604-606
race, perceptions of violence,
involuntary commitment, and
diagnosis of schizophrenia, 616-
618
Current Population Survey, 463
Cuvier, Georges, 500-501
D
Daniels, Norman, 727
Darwin, Charles, 501
Darwinism, 504
Data collection and monitoring, 21-22, 215-
234
assessment of federal policies and
practices, 220-221
INDEX
data needs and recommendations, 232-
234
data sources to assess healthcare
disparities, 223-226, 271-284
federal role in racial, ethnic, and primary
language health data, 219-223
Home Mortgage Disclosure Act
(HMDA), 651-653
models of measuring disparities in
healthcare, 226-232
in mortgage lending, 651-653
obstacles to racial/ethnic data collection,
217-219
standardizing, 215
Data Council, 221
Data needs and recommendations, 232-234
Data sources to assess healthcare
disparities, 223-226, 271-284
California Health Interview Survey
(CHIS), 225-226
commissioned papers, 273
Consumer Assessment of Health Plans
Survey (CAMPS), 223
focus groups and roundtable
discussions, 278, 284
Health Plan Employer Data and
Information Set (HEDIS), 220, 225
literature review, 271, 273
Medical Expenditure Panel Survey
(MEPS), 223-224
Medicare Current Beneficiary Survey
(MCBS), 224-225
Medicare's Enrollment Database, 224
public workshops, 273-277
study committee, 271
study components and timeline, 272
technical liaison panels, 278-283
"De-fragmentation" of healthcare financing
and delivery, 13, 182-184
Death Registration Area (DRA) system, 488
Demand-side approaches, 701-702, 706-712
consumer information, 711-712
patient cost sharing, 706-711
Demographics of healthcare providers, 114-
116. See also Patient
sociodemographics; Physician
sociodemographic characteristics
distribution of registered nurse
population in geographic areas by
racial/ethnic background, 117
nurses, 116
physicians, 114-115
OCR for page 745
INDEX
Demography, defined, 465, 522
Department for the Diseases of Children,
484
Destabilization, patchy, 508
DHHS. See U.S. Department of Health and
Human Services
Diabetes, 64, 336-337
Diagnoses
cancer, 431433
coronary artery disease, 425431
general medical and surgical care, 422-
425
HIV/AIDS, 437439
implications for change, 442444
improper, 397-398
overall pattern of evidence, 439440
racial and ethnic disparities in care, 441-
442
renal disease and kidney
transplantation, 435437
review of the evidence and a
consideration of causes, 417454
stroke, 434435
Diagnosis-related groups (DRGs), 703, 713-
715
Differences, defined, 126,159
Directory of Health and Human Services Data
Resources, 223
Disadvantaged neighborhoods, 100
Discrimination
concerns unique to immigrant
populations, 647-649
defined, 4, 159-160, 475, 523, 629-632
explaining racial and ethnic disparities
in health, 637
institutional, 95
preventing through education of
providers and patients, 660-661
Discrimination as a root cause of
disparities, 632-649
literature review, 632-637
Title VI enforcement history, 638-649
Disparities, defined, 34, 32, 126, 159
Disruptions, in the medical machine, 600-
603
Diversity, of U.S. population, growing, 181
Diversity Rx, 123
DoD. See U.S. Department of Defense
Dominant group, defined, 458, 523
Dominative racism, 494
DRA. See Death Registration Area system
745
DRGs. See Diagnosis-related groups
DSM-III, 615
DSM-IV, 608
Duke University Medical Center, 140, 429
Dyads, race-discordant, 574
E
Economics, role of, 395
ED. See Emergency department services
EEOC. See Equal Employment Opportunity
Commission
Egalitarian theories, 726-728
Elder Care Initiative, 389
Emergency department (ED) services, 153
Emergency Detention Order, 546
Emergency Medical Treatment and Active
Labor Act (EMTALA), 156-157
Emergency services, 71-74, 336-339
Employment, racial discrimination in, 100
EMTALA. See Emergency Medical
Treatment and Active Labor Act
Enalapril, racial and ethnic differences in
responses to, 7,138
End-stage renal disease (ESRD), 45, 58-60,
68, 435437
English Americans and Anglo-Protestant
culture, 483484
English common law, 458
English proficiency, limited, 640-642
Enlightenment principles, 458
Epidemics, 470
Equal Employment Opportunity
Commission (EEOC), 650
Equality, 458
Erasistratos, 498
ESRD. See End-stage renal disease
Ethical analysis of racial and ethnic
disparities in healthcare
implications for physicians, nurses, and
other providers of health care
services, 737
the neutrality thesis and the anti-
discrimination thesis, democratic
political theory, 728-729
relevance of causal stories, 729-736
when and how they matter, 722-738
Ethnic American, defined, 523
Ethnic categories for federal data
Hispanic or Latino ("Spanish origin"), 34
not Hispanic or Latino, 34
OCR for page 746
746
Ethnic groups, 495496
defined, 523
Ethnicity, defined, 462, 474, 523
Eugenics, 504
European American, defined, 523
Evidence-based cost control, 15-16,189-190
Evidence-based guidelines, promoting the
consistency and equity of care
through the use of, 16, 20, 189-190
Evidence of race-concordance
consequences for the
communication process, 574
Evidence of racial and ethnic disparities in
healthcare, 5-6, 38-77
analgesia, 64-66, 290-295, 326-327
asthma, 62-63, 296-297
cancer, 52-57, 298-305
cardiovascular disease, 39, 42-52, 306-
325, 328-329
cerebrovascular disease, 57-58, 328-331
children's health services, 68-69, 330-335
diabetes, 64, 336-337
emergency services, 71-74, 336-339
extent of, 76-77
eye care, 71-74, 338-341
gallbladder disease, 71-74, 340-341
HIV/AIDS, 61-62, 342-343
maternal and infant health, 66-68, 344-
349
mental health services, 69-71, 348-353
needed research, 75-76
other clinical and hospital-based
services, 71-74
patient perceptions, 71-74, 358-359
peripheral vascular disease, 71-74, 352-
355
pharmacy services, 71-74, 352-355
physician perceptions, 71-74, 354-359
radiographic services, 71-74, 360-361
rehabilitative services, 66, 360-363
renal transplantation, 58-60, 362-365
use of services and procedures, 71-74,
364-377
vaccination, 71-74, 374-375
women's health services, 376-379
EXCEED. See Excellence Centers to
Eliminate Ethnic/Racial
Disparities
Excellence Centers to Eliminate Ethnic/
Racial Disparities (EXCEED), 388
Exclusion, defined, 475
INDEX
Executive Office of the President, 384
Office of Management and Budget, 384
Executive Orders, 657
Eye care, 71-74, 338-341
F
Fadiman, Anne, 605
Failed reform and corporate takeover, 508
Fair Housing Act, 98-99
Federal Employees Health Benefits Plan
(FEHBP), 699n
Federal Financial Institutions Examination
Council (FFIEC), 652
Federal healthcare financing programs
supported through direct public
funding. See also Medicaid;
Medicare; State Children's Health
Insurance Program (SCHIP)
health disparities and Medicare and
Medicaid administration, 681-693
health problems and long-term care
needs of minority and non-
minority individuals, 671
issues in the design, structure, and
administration of, 664-698
overview, 667-673
poverty rates among minority and non-
minority individuals, 672
racial and ethnic minority Americans as
a share of the elderly population,
671
supplemental insurance coverage among
minority and non-minority
Medicare beneficiaries, 672
Federal-level and other initiatives to
address racial and ethnic
disparities in healthcare, 235, 384-
391
Cambridge Health Alliance, 391
Department of Health and Human
Services (DHHS), 384-391
Department of Veterans Affairs, 391
Executive Office of the President, 384
Federal policies and practices, assessment
of, 220-221
Federal Register, 640, 651
Federal role in racial, ethnic, and primary
language health data, 219-223
Federally Qualified Health Center, 536
Fee-for-service health systems, 75, 705
OCR for page 747
INDEX
FEHBP. See Federal Employees Health
Benefits Plan
FFIEC. See Federal Financial Institutions
Examination Council
Financial incentives in healthcare, 16-17,
190-191
Financing challenge, critical, 658-659
Flexner, Abraham, 105, 458
Focus
on attitudes, 203-204
on knowledge, 204-206
on skills, 206-207
Focus group findings about racial and
ethnic disparities in healthcare,
392405
identifying racial and ethnic
discrimination, 398402
inclusion of and respect for culture in
healthcare experiences, 403405
institutional discrimination in
healthcare, 402403
stories of racial discrimination in
healthcare practice, 392-398
Focus groups, roundtable discussions, 278,
284
Folk illnesses and healing practices, 205
Ford Foundation, 421
Fragmentation of healthcare systems, 147-
148
along socioeconomic lines, avoiding, 13,
20,184
Freedmen's Bureau, 502-503
G
Galen, 498-499
Gallbladder disease, 71-74, 340-341
Gamble, Vanessa, 634
GAO. See General Accounting Office
Geiger, Jack, 627n, 660
General Accounting Office (GAO), 687
General medical and surgical care, 422425
General Social Survey (GSS), 93
Geographic factors, 117, 144, 286, 488n
George Washington University Center for
Health Services Research and
Policy, 690
German Americans, 484
German Dispensary, 484
German hospitals, 484
Glaucoma, 71
747
Glazer, Nathan, 496
Great Chain of Being, 497
Great Depression and World War II, 505
Greco-Roman world, 498
GSS. See General Social Survey
Guidance on Aggregation and Allocation
of Data on Race for Use in Civil
Rights Monitoring and
Enforcement, 384
H
Hafferty, Fred, 599
Harlem Hospital, 661
Harvard Medical Practice Study, 598
Harvard Medical School, 599, 633
Harvard School of Public Health, 489, 633
HCFA. See Health Care Financing
Administration
Health, defined, 523
"Health Accountability 36," 226-228
Health Care Divided, Race and Healing a
Nation, 638
Health Care Financing Administration
(HCFA), 222-223, 389, 418, 420,
436, 536-537
database of, 423
Health deficit, defined, 525
Health disparities and Medicare and
Medicaid administration, 548,
681-693
choices in establishing conditions of
participation and quality of care
management, 690-691
choices in provider payment, 687-689
choices in setting eligibility standards
and enrollment arrangements,
685-687
choices in the design of managed care
systems, 691-693
concentration of poverty, in 100 largest
U.S. cities, 688
conditions of physician participation,
683-684
issues underlying racial disparities, 684-
685
separate SCHIP programs, 689-690
Health insurance coverage. See also
Insurance status of racial and
ethnic groups
among Latino subgroups, 88
OCR for page 748
748
by Asian-American and Pacific Islander
subgroups vs. whites, 86
by race and ethnicity, 679-680
Health Insurance Portability and
Accountability Act (HIPAA), 217,
220, 222, 243
Health maintenance organizations (HMOs),
54, 63, 75, 704-705, 715-716
mandatory enrollment in, 8
staff-model, 115
Health Plan Employer Data and
Information Set (HEDIS), 220, 225,
231, 234, 711
Health plan payments
to primary care physicians, 704
to specialists, 704
Health plans, disclosing clinical protocols
of, 16
Health professionals, increasing the
proportion of underrepresented
U.S. racial and ethnic minorities
among, 14, 20, 186
Health Resources and Services
Administration, 385, 388-389
Community Access Program (CAP), 388-
389
Measuring Cultural Competence in
Health Care Delivery Settings, 388
Oral Health Initiative, 389
Provider's Guide to Quality and Culture,
389
Health Security Act, 705
Health services, defined, 31
Health status of racial and ethnic minority
populations, 81-83
age-adjusted death rates for all causes of
death by race and Hispanic
origin, 82
age-adjusted death rates for selected
causes of death by race and
Hispanic origin, 83
Health system interventions, 15-18, 188-196
community health workers, 17-18, 193-
195
evidence-based cost control, 15-16, 189-
190
financial incentives in healthcare, 16-17,
190-191
interpretation services, 17, 191-193
multidisciplinary teams, 195-196
Healthcare, defined, 31, 523
INDEX
Healthcare disparities
addressing through the training of
healthcare professionals, 606-611
among non-African American minority
groups, 240
improving research on, 242-243
sources of, 125-130
Healthcare dollars, 536-537
Healthcare environment, 80-124
brief history of legally segregated
healthcare facilities, 103-108
contemporary defacto segregation, 103-108
health status of racial and ethnic
minority populations, 81-83
healthcare professions workforce in
minority and medically
underserved communities, 114-
120
historical determinants of contemporary
minority health professions
workforce, 105-108
historical overview of healthcare
delivery for racial and ethnic
minority patients, 102-103
insurance status of racial and ethnic
minority populations, 83-87
linguistic barriers of racial and ethnic
minority populations, 87-90
participation of racial and ethnic
minorities in health professions
education, 120-123
racial attitudes and relations, 91-95
racial discrimination, 95-101
relationship to broader racial attitudes
and discrimination, 6-7, 101-102
settings in which racial and ethnic
minorities receive healthcare, 108-
114
Healthcare facilities, producing unique
scores for, 229
Healthcare professions workforce in
minority and medically
underserved communities, 114-
120
demographics of healthcare providers,
114-116
impact of international medical
graduates (IMGs) on the
workforce in minority
communities, 116-120
top 10 countries with highest proportion
of medical graduates, 119
OCR for page 749
INDEX
Healthcare providers, 89-90
biases in social stereotypes and attitudes,
169-171
clinical uncertainty, 167-169
consequences of stereotypes, 171-172
functions of stereotypes and attitudes, 169
prejudice, 10-11, 162-174
provider beliefs and stereotypes, 169
stereotypes and healthcare disparities,
172-174
Healthcare services, defined, 31
Healthcare settings, 400
influence on care for minority patients,
237-239
Healthcare systems-level factors, 8-9
Healthcare systems-level variables, 140-159
availability and access to services, 143-
144
fragmentation of healthcare systems,
147-148
language barriers, 141-143
legal and regulatory policy and
healthcare disparities, 155-159
managed care revolution, 150-154
maneuvering through clinical
bureaucracies, 144-145
referral patterns and access to specialty
care, 145-146
shedding some negative aspects of the
past, 508-510
supply-side cost containment and
demand for clinical services, 154-
155
U.S. Department of Defense and
Veterans Administration
healthcare systems, 148-150
Healthcare workforce, 80
"Healthy Families" programs, 90
Healthy People 2000, 226
Healthy People 2010, 37, 385
Heckler, Margaret, 487
HEDIS. See Health Plan Employer Data and
Information Set
Henry J. Kaiser Family Foundation, The,
123, 421
Herophilos, 498
Herzog, Maximillian, 484
HHS. See U.S. Department of Health and
Human Services
HHS-wide initiatives, 384-385
Hill-Burton Act, 631, 682n
749
Hip fractures, 66
Hippocratic Oath, 497498
Hispania, 480
Hispanic Americans, 87-88, 480-482
defined, 32n, 34, 463, 523
subgroups, 482
Hispanic Colorectal Cancer Outreach and
Education Project, 387
Hispanic Medical Association (HMA), 421
Historical determinants, of contemporary
minority health professions
workforce, 105-108
Historical perspective, on inequities and
bias, 496497
Historical thinking, 496
History of racial and ethnic disparities in
healthcare, 102-103, 455-527
American Indians or Alaska Natives,
477-478, 528-534
American racial and ethnic relations,
458460
Asian Americans or Pacific Islanders,
478480
Blacks or African Americans (not of
Hispanic origin), 475-477
changing concepts of race and ethnicity,
490496
dynamics of the U.S. racial and ethnic
group interaction, 473475
English Americans and Anglo-Protestant
culture, 483484
German Americans, 484
Hispanics, 480482
immigration, racial and ethnic groups,
health and healthcare, 464465,
470473
Irish Americans, 485
Italian Americans, 485486
Jewish Americans, 486
North American health and health care,
466469
Polish Americans, 486-487
racial and ethnic data collection and
definitions, 460464
racial and ethnic health and healthcare
disparities and their
documentation in the U.S., 487-
489
white non-Hispanic ethnic groups, 482-
483
HIV/AIDS, 61-62, 342-343, 437-439
OCR for page 754
754
Meriam Report, 477, 531
Merton, Robert K., 599
Metaracism, 494
Mexican Americans, 87, 614
MI. See Myocardial infarction
Middle Ages, 498499
Minority, defined, 524
Minority Health, 528
Minority HIV/AIDS initiative, 384-385
Minority patients
mistrust and experiences of
discrimination, 135-136
preferences regarding providers and
racial concordance, 132-135
Minority stereotype, defined, 524
Minority youth, in the juvenile justice
system, 100-101
"Misanthropy Scale," 209
Misdiagnosis, 614-616
Mistrust, 174-175
MMIA. See Massachusetts Medical
Interpreter Association
Model minority stereotype, defined, 524
Models for measuring disparities in
healthcare, 226-232
"Health Accountability 36," 226-228
integrated approaches, 227, 229-231
reporting of racial and ethnic disparities
using existing data sets, 231-232
Monitoring healthcare disparities, 241
Monitoring progress, toward elimination of
healthcare disparities, 21-22, 234
Moon, Marilyn, 667, 694
Moral foundations, 724-729
Mortgage lending, racial discrimination in,
96
Morton, Samuel George, 501
MOS. See Medical Outcomes Study
Mt. Sinai Hospital, 486
Multicultural/categorical approach, 204-
206
Multidisciplinary treatment and preventive
care teams, implementing, 18, 21,
195-196
Multinational capitalism, advanced, 468-
469
Muslim culture, 205, 498
Myocardial infarction (MI), 43-45, 59, 71,
134, 137
Myrdal, Gunnar, 417, 444
INDEX
N
NAACP, 505
NACHM. See National Advisory
Commission on Health
Manpower
NALS. See National Adult Literacy Survey
Namias, Barbara, 536
National Adult Literacy Survey (NALS),
571
National Advisory Commission on Health
Manpower (NACHM), 118
National Alliance for Hispanic Health, 387
National Board of Medical Examiners, 209
National Breast and Cervical Cancer Early
Detection Program (NBCCEDP),
387
National Cancer Institute (NCI), 53, 226
National Center for Vital and Health
Statistics, 81
National Center on Minority Health and
Health Disparities (NCMHD),
390, 420, 597
National Committee for Quality Assurance
(NCQA), 225, 227, 231, 233-234,
711
State of Managed Care Quality report, 231
National Committee on Vital and Health
Statistics (NCVHS), 219, 222
National Comprehensive Cancer Control
(CCC) Program, 387
National Consumer Assessment of Health
Plans (CAMPS), 69
National Council of Urban Indian Health,
536
National Council on Interpretation in
Healthcare, 193
National Diabetes Program, 389
National Health Interview Surveys, 429
National Health Law Program (NHeLP),
219-222, 656
National Health Service (NHS), 112, 441
National Hospital Discharge Survey
(NHDS), 43
National Indian Council on Aging
(NICOA), 537
National Indian Health Board, 531, 534, 537
National Institute of Mental Health
(NIMH), 617
Epidemiological Catchment Area
studies, 617
OCR for page 755
INDEX
National Institutes of Health (NIH), 63, 243,
385, 389-390, 420, 597, 600
National Center on Minority Health and
Health Disparities, 390
strategic research agenda on health
disparities, 389-390
National League for Nursing, 203
National Medical Association (NMA), 108,
421, 503, 643, 662
National Program of Cancer Registries, 387
National Quality Forum (NQF), 216, 219, 226
National Training Center, 387
National Vital Statistics report system, 226
Native Hawaiian, 34
defined, 34
Naturalization Law of 1790, 459
Navajo language, 89
NBCCEDP. See National Breast and
Cervical Cancer Early Detection
Program
NCI. See National Cancer Institute
NCMHD. See National Center on Minority
Health and Health Disparities
NCQA. See National Committee for
Quality Assurance
NCVHS. See National Committee on Vital
and Health Statistics
"Negro medical ghetto," 503, 505
Neighborhood health centers (NHCs), 506
Neighborhoods, systematically
disadvantaged, 100
NEJM. See New England Journal of Medicine
Neutrality thesis, 722
Neutrality thesis and the anti-
discrimination thesis
democratic political theory, 728-729
differences between, 723-724
Egalitarian theories, 726-728
Libertarian theories, 725-726
moral foundations for, 724-729
New England Journal of Medicine (NEJM),
419, 594, 606, 632
New Jersey State Police, 654
New York Medical College, 484
Newsday, 646
NHCs. See Neighborhood health centers
NHDS. See National Hospital Discharge
Survey
NHeLP. See National Health Law Program
NHS. See National Health Service
NICOA. See National Indian Council on
Aging
755
NIH. See National Institutes of Health
NIMH. See National Institute of Mental
Health
NMA. See National Medical Association
NNRTI. See Nonnucleoside reverse
transcriptase inhibitors
Noeggerath, Emil, 484
Non-hospital facilities, site of care in, 111
Non-physician health professionals, 239-
240
Nonnucleoside reverse transcriptase
inhibitors (NNRTI), 61
NQF. See National Quality Forum
Nurses, 116
o
Obstacles to racial/ethnic data collection,
217-219
OCR. See Office of Civil Rights
OEO. See Office of Economic Opportunity
Office for Civil Rights (OCR), 15, 157, 187,
192, 218, 385-386, 630-631, 638-
649, 656
Limited English Proficiency Guidelines,
695
Office of Economic Opportunity (OEO),
531
Office of Indian Affairs, 530
Office of Management and Budget, 32, 227,
234, 384, 461, 463
Guidance on Aggregation and
Allocation of Data on Race for
Use in Civil Rights Monitoring
and Enforcement, 384
Standards for the Classification of
Federal Data on Race and
Ethnicity, 32
Office of Minority Health (OMH), 181, 192,
218, 385, 420
Resource Center, 385
Office of the Secretary of DHHS, 385-386
Cross Cultural Health Care Program, 385
Healthy People 2010, 37, 385
Office for Civil Rights (OCR), 385-386
Office of Minority Health (OMR), 385
Office on Women's Health, 385
Ohio State University Medical Center, 197
OJJDP. See U.S. Office of Juvenile Justice
and Delinquency Prevention
OMH. See Office of Minority Health
OCR for page 756
756
Opioid supplies, availability of, 8
Oral Health Initiative, 389
Other, the, 609
"Overcompensation," 134
Overuse of clinical services, by white
patients, 139-140
p
Pacific Business Group on Health, 711
Pacific Islander, 34
defined, 34, 522
Page Act of 1875, 459
Paired testing strategies, 188n
Pap smears, 194
Paperwork Reduction Act, 217
Participation, of racial and ethnic
minorities in health professions
education, 120-123
Participatory decision-making (PDM), 132,
559, 572-574
Paternalistic racism, 493
Patient- and system-level factors, 125-159
Patient education programs, implementing,
19, 21, 198
Patient-level variables, 7-8, 131-140, 237
biological differences that may justify
differences in receipt of care, 138-
139
minority patient mistrust and
experiences of discrimination,
135-136
minority patient preferences regarding
providers and racial concordance
132-135
overuse of clinical services by white
patients, 139-140
patient refusal of recommended
treatment, 136-138
patients' preferences, 131-135
role of preferences, treatment refusal,
and the clinical appropriateness of
care, 7-8
Patient-provider communication, 552-593
consequence of race concordance on
patient reports of physician
participatory decision-making
(PDM) style and other aspects of
communication, 572-574
correlates of communication, 557-558
INDEX
evidence of race-concordance
consequences for the
communication process, 574
implications for physician training and
patient activation to improve
patient-physician
communications within culturally
diverse populations, 575-577
nature and consequences of broad
normative expectations, bias, and
racial stereotyping by providers
and patients, 556-557
needed research, 577-579
physician role obligations and
medicine's unwritten social
contract, 556
relationship between communication
style and patient satisfaction and
health outcomes, 574-575
role and impact of patient
sociodemographics on medical
communication, 562-572
role of cross-cultural training for
healthcare professionals, 579-580
role of physician sociodemographic
characteristics on the medical
dialogue, 558-564
scope of topic, 553-555
Patient sociodemographics
age, 565-567
gender, 565
health status, 569-570
literacy, 570-572
race and ethnicity, 562-565
social class, 567-569
Patients
appearance, 399
cost sharing by, 706-711
as discretionary actors, 128
economic/insurance status, 399-400
education and empowerment, 18-19,196-
198
perceptions, 71-74, 358-359
preferences, 131-135
protecting, 14-15, 186-187
refusal of recommended treatment, 136-
138
response by, 12, 174-175
role and impact on medical
communication, 562-572
OCR for page 757
INDEX
Patients and Healers in the Context of Culture,
607
PCP. See Pneumocystis carinii pneumonia
PDM. See Participatory decision-making
Percutaneous transluminal coronary
angiography (PTCA), 44-49, 139-
140, 149-150
Peripheral artery disease, 74
Peripheral vascular disease, 71-74, 352-355
Personally mediated racism, defined, 524
Pew Health Professions Commission, 203
Pharmacy services, 71-74, 352-355
PHS. See U.S. Public Health Service
Physician "gag" clauses, banning, 14
Physician role obligations, medicine's
unwritten social contract, 556
Physician sociodemographic characteristics
gender, 559-560
race and ethnicity, 558-559
social class, 560-562
Physicians, 114-115
perceptions by, 71-74, 354-359
role in the medical dialogue, 558-564
Physician's fees, low, 712-713
PI. See Protease inhibitors
Pittsburgh Police Department, 654
Plato, 497498
Pneumocystis carinii pneumonia (PCP), 61-
62
Pneumonia, 72
Pocket guide and desk reference, 390
Polish Americans, 486-487
Political correctness, 604-606
Political economy, of cultural practices in
medicine, 621
"Polygenism," 501
Populations. See also Current Population
Survey; Measures of Quality of
Care for Vulnerable Populations
defined, 31
elderly, 671
growing diversity of U.S., 181
health status of, 81-83
immigrant, 647-649
insurance status of, 83-87
nurses, 117
with equal access to healthcare, 4, 33
Positron tomography, 129
Postmodernism, 495n
Poverty rates, among minority and non-
minority individuals, 672
757
Practice arrangements, of minority
physicians, 621
Pre-Columbian and North American
development, 466-467
Preferences, defined, 4n
Prejudice, defined, 524
"Prejudice-related conflict," 616
Prescription services, 73
Prichard, James Cowles, 501
Primary care visits, made to primary care
delivery sites by health insurance
payer and race/ethnicity, 113
Professional interpretation services,
increasing linguistic diversity in
the U.S. requires increase in, 193
Proficiency, limited, in English, 640-642
Program successes redressing imbalances
in care, assessment of, 621
Prostate cancer screening behaviors, 387
Protease inhibitors (PI), 61
Providers
beliefs and stereotypes, 169
perspectives, 211
Provider's Guide to Quality and Culture,
389
PTCA. See Percutaneous transluminal
coronary angiography
Public Health Institute, 225
Public Health Service Act, 680
Public workshops, 273-277
PUBMED database, 285
Puerto Rican Americans, 87
Q
Quality Compass database, 231
Quality of care
defined, 31
received by tribal communities, 539-543
R
Race
defined, 490, 524-525
ethnicity and immigration
advanced industrial (multinational)
capitalism, 468469
commercial capitalism and the slave
society, 466467
industrial capitalism, 466469
OCR for page 758
758
North American health and health
care, 466469
pre-Columbian and North American
development, 466-467
perceptions of violence, involuntary
commitment, and diagnosis of
schizophrenia, 616-618
Race-discordant dyads, 574
Racial and Ethnic Approaches to
Community Health (REACH),
386-387
Racial and ethnic disparities in healthcare
assessing potential sources of, 7-12
assumptions, 34, 30-35
background and history, 455-527
bias, stereotyping, prejudice, and clinical
uncertainty on part of healthcare
providers contributing to, 12, 19,
178
civil rights dimension of, 626-663
culture of medicine and, 594-625
data collection and monitoring, 21-22,
215-234, 460-464
defining, 34
diagnosis and treatment of, 417-454
ethical analysis of when and how they
matter, 722-738
evidence of, 5-6, 38-77
existence and unacceptability of, 6, 19, 79
federal-level and other initiatives to
address, 235, 384-391
focus group findings, 392405
global problem, 441442
health disparities and Medicare and
Medicaid administration, 681-693
healthcare environment and its relation
to, 80-124
impact of cost containment efforts on,
699-721
importance of, 36-38
interventions to eliminate, 13-20
many sources contributing to, 12, 19, 159
minority patients more likely than white
patients to refuse treatment, 8, 19,
179
occurring in the context of broader
historic and contemporary social
and economic inequality, 6-7, 19,
123
patient-provider communication, 552-
593
INDEX
populations with equal access to
he althc are, 4 , 33
relationship of health status to, 35-36
relationship to broader racial attitudes
and discrimination, 101-102
revised standards for the classification of
federal data on race and ethnicity,
34
their documentation in the U.S., 487-489
Racial and ethnic minority groups
defined, 32-33
share of the elderly population, 671
Racial attitudes
discrimination in the United States, 6-7
relations, 91-95
Racial categories for federal data
American Indian or Alaska Native, 34
Asian, 34
Black or African American, 34
Native Hawaiian or other Pacific
Islander, 34
White, 34
Racial discrimination, 95-101
in criminal justice, 100-101
minority youth in the juvenile justice
system, 100-101
defined, 95-96
in employment, 100
in housing, 96-100
in mortgage lending, 96
Racial groups
defined, 525
hierarchies, 490493
Racial models, as tools for analysis and
understanding, 493-495
Racial profiling, the importance of data
collection, 654-655
Racism, 491
aversive, 494
competitive, 493
dominative, 494
ideological, 523
individual, 493
institutionalized, 494
internalized, 494, 524
paternalistic, 493
personally mediated, 494, 524
scientific, 501, 504, 525
societal, 493
Racism in Medicine: An Agenda for Change,
441
OCR for page 759
INDEX
Radiographic services, 71-74, 129, 360-361
RAND criteria, 45, 48, 57, 139, 143, 149
RAND Health Insurance Survey, 702, 707,
709-710
Rationing of healthcare for American
Indians/Alaska Natives, 528-551
addressing health disparities, 548
changes in the healthcare arena, 534-535
compacting/contracting and
improvement in quality of care,
543-545
effect of discrimination on quality of care
for tribal members, 545-548
healthcare dollars, 536-537
history of health disparities among
American Indians/Alaska
Natives, 528-534
interviews, 539
quality of healthcare received by tribal
communities, 539-543
tribal/consumer perspectives, 537-539
Rawls, John, 726-728
REACH 2010. See Racial and Ethnic
Approaches to Community
Health
Recommendations
applying same managed care protections
to publicly funded HMO
enrollees, 15, 20, 187
avoiding fragmentation of health plans
along socioeconomic lines, 13, 20,
184
collecting and reporting data on
healthcare access and utilization
by patient race, ethnicity,
socioeconomic status, and
primary language, 21-22, 233
conducting further research to identify
sources of radial and ethnic
disparities and assessing
promising intervention strategies,
23, 242-243
conducting research on ethical issues
and other barriers to eliminating
disparities, 23, 243
enhancing patient-provider
communication and trust by
providing financial incentives for
practices that reduce barriers, 17,
20, 191
759
implementing multidisciplinary
treatment and preventive care
teams, 18, 21, 196
implementing patient education
programs to increase patients'
knowledge of how to best access
care and participate in treatment
decisions, 19, 21, 198
including measures of racial and ethnic
disparities in performance
measurement, 21-22, 233-234
increasing awareness of racial and ethnic
differences in healthcare among
healthcare providers, 6, 20, 124
increasing awareness of racial and ethnic
differences in healthcare among
the general public and key
stakeholders, 6, 20, 124
increasing the proportion of
underrepresented U.S. racial and
ethnic minorities among health
professionals, 14, 20, 186
integrating cross-cultural education into
training of all current and future
health professionals, 20-21, 214
monitoring progress toward elimination
of healthcare disparities, 21-22,
234
promoting the consistency and equity of
care through the use of evidence-
based guidelines, 16, 20, 189-190
providing greater resources to the U.S.
DHHS Office for Civil Rights to
enforce civil rights laws, 15, 20,
188
reporting racial and ethnic data by
federally defined categories, 21-
22, 234
strengthening the stability of patient-
provider relationships in publicly
funded health plans, 14, 20, 185
structuring payment systems to ensure
an adequate supply of services to
minority patients, 17, 20, 190-191
supporting the use of community health
workers, 18, 21, 195
supporting the use of interpretation
services where community need
exists, 17, 20, 193
Reconstruction, in Black health, 509
OCR for page 760
760
Redlining, 642-643
Reducing Health Care Disparities National
Project, 388
Reductionism, defined, 525
Reductionist thinking, 496
Referral patterns, access to specialty care,
145-146
Refusal of service, 174-175
Registered nurse population, distribution
in geographic areas by racial/
ethnic background, 117
Rehabilitative services, 66, 360-363
Relevance of causal stories, 729-736
brute luck and social structural
Egalitarian views of causality,
732-734
Libertarian views of the relevance of
causal explanations, 730-732
relevance of individual causal
responsibility, 734-736
Renaissance, 499
Renal disease, 30, 435437
Renal transplantation, 58-60, 362-365, 435-
437
Reporting data on healthcare access and
utilization, by patient race,
ethnicity, socioeconomic status,
and primary language, 21-22, 233
Reporting racial and ethnic data by
federally defined categories, 21-
22, 234
Reporting racial and ethnic disparities
using existing data sets, 231-232
Republican period, 501
Research needed, 22-23, 235-243, 619-621
assessment of program successes
redressing imbalances in care, 621
changes in the ethnicity and race of
medical students, physicians,
nurses, and healthcare staff, 621
clinical decision-making and the roles of
stereotyping, uncertainty, and
bias, 236-237
contribution of healthcare to health
outcomes and the health gap
between minority and non-
minority Americans, 241-242
critical analysis of the culture of
medicine, 620-621
effectiveness of intervention strategies,
240-241
INDEX
healthcare disparities among non-
African American minority
groups, 240
identification of successful interventions
and programs in medical and
nursing education, 621
improving research on healthcare
disparities, 242-243
influence of healthcare systems and
settings on care for minority
patients, 237-239
monitoring healthcare disparities, 241
patient-level influences on care, 237
political economy of cultural practices in
medicine, 621
practice arrangements of minority
physicians, 621
roles of non-physician health
professionals, 239-240
studies of DoD and VA systems, 238
studies within healthcare plans, 237-238
types of hospital or clinic and racial and
ethnic disparities in care, 238-239
Respect, lack of, 396-397
Retrenchment era in healthcare, 507-508
Revascularization, 74, 427
Revised standards for the classification of
federal data on race and ethnicity,
34
Revolutionary War, 470, 489
Robert Wood Johnson Foundation, 421, 620
Roman Empire, 498
S
Sacher, David, 611, 620
St. Francis Hospital, 485
St. Vincent's Hospital, 485
SAMHSA. See Substance Abuse and Mental
Health Services Administration
San Diego County Sheriff's Department,
655
Sandoval decision. See Alexander v. Sandoval
Sanitary Commission Anthropometric
Study, 502
Scala nature, 497
SCHIP. See State Children's Health
Insurance Program
Schizophrenia, African Americans and the
"over-diagnosis" of, 612-613
Schulman, Kevin, 635
OCR for page 761
INDEX
Scientific racism, 501, 504
defined, 525
Search keywords, 40
Segregation, contemporary de facto, 103-108
Sen, Amartya, 728
Service use, 71-74, 364-377
SES. See Socioeconomic status
Settings in which racial and ethnic
minorities receive healthcare, 108-
114
impact of community health centers on
healthcare in minority and
medically underserved areas, 112,
114
primary care visits made to primary care
delivery sites by health insurance
payer and race/ethnicity, 113
site of care in hospital settings, 110
site of care in non-hospital facilities, 111
site of usual source of care, by health
insurance payer and race/
ethnicity, 111
those having no usual source of medical
care, 109
Shalala, Donna, 626, 657, 659
SHIRE. See Summit Health Institute for
Research and Education, Inc.
Site of usual source of care, by insurance
and race/ethnicity, 111
Slave health deficit, defined, 525
Slave health subsystem, 470-471
defined, 525
Slave trade, 499-500
Slavery, 458
Smedley, Audrey, 490
Smith, Charles Hamilton, 501
Smith, David Barton, 638
Smith, Sally, 531
Snyder Act of 1921, 532-533
Social Security Act, Title XXI, 680-681
Social Security Administration (SSA), 220,
223, 649, 668
"Enumeration at Birth" program, 649
Master Beneficiary Record database, 224
Social structural Egalitarian views of
causality, brute luck and, 732-734
Societal racism, 493
Sociocultural thinking, 496
Socioeconomic status (SES), 68, 75, 166-167,
286, 557-558, 595, 635
Sources of health insurance by race and
ethnicity, 84
761
Sources of medical care, those having no
usual, 109
Sources of racial and ethnic disparities in
healthcare
assessing potential, 7-12
clinical encounter, 160-179
clinical uncertainty, 9
healthcare provider prejudice or bias, 10-
11
healthcare systems-level factors, 8-9
implicit nature of stereotypes, 10
medical decisions under time pressure
with limited information, 11-12
patient- and system-level factors, 125-159
patient-level variables, 7-8
patient response, 12
role of bias, stereotyping, and
uncertainty, 9-12
Southwest Native American Cardiology
Program, 389
Sowell, Thomas, 496
Spanish heritage, 480-481, 564
"Spanish Language and Cultural
Competence Curriculum," 209
Special Programs Development Branch, 391
Specialized HIV/AIDS outreach and
substance abuse treatment, 390
Spirit Catches You and You Fall Down, The,
605
SSA. See Social Security Administration
Staff-model HMOs, 115
Standardizing data collection, 215
Standards, Training and Certification (STC)
Committee, 193
Standards for the classification of federal
data on race and ethnicity, 34
American Indian or Alaska Native, 34
Asian, 34
Black or African American, 34
Hispanic or Latino ("Spanish origin"), 34
Native Hawaiian or other Pacific
Islander, 34
not Hispanic or Latino, 34
White, 34
Standards of mental healthcare, for Latinos,
390
Standards on Cultural and Linguistic
Competence in 2000, 660
State Children's Health Insurance Program
(SCHIP), 68, 220, 222, 629, 651,
659-660, 673-681
applying for, 637, 648
OCR for page 762
762
STC. See Standards, Training and
Certification Committee
Stereotypes
defined, 475, 525
effect of, 392-393
healthcare disparities, 172-174
implicit nature of, 10
minority, defined, 524
Stinson, Nathan, 528
Stories about misdiagnosis or improper
treatment, 401402
Stories of racial discrimination in
healthcare practice, 392-398
effect of stereotyping, 392-393
improper diagnosis or treatment, 397-
398
lack of respect, 396-397
language barriers, 393-395
role of economics, 395
Strategic Research Agenda, 390
Strengthening
doctor-patient relationships, 13-14,184-
186
federal, state, and private healthcare,
655-657
stability of patient-provider relationships
in publicly funded health plans,
14, 20, 185
Stroke, 434-435
Structural thinking, 496
Structuring payment systems to ensure an
adequate supply of services to
minority patients, 17, 20, 190-191
Student Physician, 599
Studies
assess appropriateness of services, 48-49
DoD and VA systems, 238
healthcare plans, 237-238
role of financial and institutional
characteristics, 4548
using administrative databases, 4245
Subculture, defined, 525-526
Subjectivity
uncertainty, 128-130
variability, 128
Subordinate group, defined, 458, 526
Substance Abuse and Mental Health
Services Administration
(SAMHSA), 385, 390-391
American Indian and Alaskan Native
Planning Grants, 391
INDEX
Community Action Grant Program, 390
pocket guide and desk reference, 390
Special Programs Development Branch,
391
specialized HIV/AIDS outreach and
substance abuse treatment, 390
standards of mental healthcare for
Latinos, 390
Summit Health Institute for Research and
Education, Inc. (SHIRE), 219-222
Sunshine Amendment, 654
Supplemental insurance coverage, among
minority and non-minority
Medicare beneficiaries, 672
Supplemental Security Income, 675
Supply-side approaches, 703-705, 712-718
capitation and DRGs, 713-715
cost containment and demand for
clinical services, 154-155
health plan payments to primary care
physicians, 704
health plan payments to specialists, 704
low physician fees, 712-713
supply, technology, and expenditure
controls, 717-718
utilization review and practice
guidelines, 716-717
Supreme Court. See U.S. Supreme Court
. . .
Recisions
Surgeon General, 611, 614
System strategies, 180-198
Systema Naturae, 499
Systematically disadvantaged
neighborhoods, 100
T
Task Force on Black and Minority Health,
417
Teaching methods and opportunities, 207-
209
Technical liaison panels, 278-283
Terry, Robert W., 493
Test of Functional Health Literacy
Assessment (TOFHLA), 570-571
Thai language, 89
Therapeutic cardiac procedures, 149
"Therapeutic social control," 616
Third World IMGs, 116-120
TIA. See Transient ischemic attack
OCR for page 763
INDEX
Title VI, 157, 159, 188, 192, 221, 628-631,
637-641, 668, 679. See also Civil
Rights Act
access to medical treatment, 645-647
.. . . . .
a~scr~m~nahon concerns unique to
immigrant populations, 647-649
enforcement history and the types of
discrimination, 638-649
intentional discrimination, 639-640
limited English proficiency, 640-642
managed care, 643-645
redlining, 642-643
Title VII, 631
TOFHLA. See Test of Functional Health
Literacy Assessment
Tools, Robert, 2
Transient ischemic attack (TIA), 57, 434435
Translating Research into Practice (TRIP),
386
Treatment
cancer, 431433
coronary artery disease, 425431
general medical and surgical care, 422-
425
HIV/AIDS, 437439
implications for change, 442444
improper, 397-398
overall pattern of evidence, 439440
racial and ethnic disparities in care, 441-
442
renal disease and kidney
transplantation, 435437
review of the evidence and a
consideration of causes, 417454
stroke, 434435
Triage scoring, 153
Tribal/consumer perspectives, 537-539
TRIP. See Translating Research into Practice
Trujillo, Michael, 530
Tuskeegee Syphilis Study, 131, 205
U
UCLA Center for Health Policy Research,
225
UCLA criteria, 48, 139
UCLA Medical Center, emergency
department, 65
Underrepresented minority (URM)
students, 121-122
763
Understanding and Eliminating Minority
Health Disparities Initiative, 386
Unfulfilled potential of Title VI, 157-159
United Hospital Fund, 658
United Network for Organ Sharing, 436
United States-United Kingdom
Collaborative Initiative on Racial
and Ethnic Health, 441
United States v. Albank, 653
United States v. Decatur Federal Savings and
Loan, 653
University of California at Davis, 596
University of New Mexico School of
Medicine, 597
University of Southern California Medical
School, 634
Urban Institute, 96
URM. See Underrepresented minority
students
U.S. Census Bureau, 81, 199, 461-463, 475,
479, 481, 488
U.S. Civil Rights Commission, 684
U.S. Constitution, 459
U.S. Department of Agriculture, 648
U.S. Department of Defense (DoD),
healthcare systems, 51, 148-150,
431, 433
U.S. Department of Education, 571, 650
National Adult Literacy Survey (NALS),
571
U.S. Department of Health, Education, and
Welfare, 531. See also U.S.
Department of Health and
Human Services
U.S. Department of Health and Human
Services (DHHS), 15, 123, 157, 159,
187, 192-193, 216-224, 226, 227n,
232, 234, 384-391, 487-488, 630,
650, 657-660
Agency for Healthcare Research and
Quality (AHRQJ, 386
Centers for Disease Control and
Prevention (CDC), 386-388
Centers for Medicare and Medicaid
Services (CMS), 388
"Closing the Health Gap" campaign, 123
Data Council, 221
Directory of Health and Human Services
Data Resources, 223
Health Resources and Services
Administration, 388-389
OCR for page 764
764
Healthy People 2000, 226
HHS-wide initiatives, 384-385
Indian Health Service (IHS), 389
Minority HIV/AIDS initiative, 384-385
monitoring by, 158
National Institutes of Health (NIH), 389-
390
Office for Civil Rights (OCR), 15, 157,
187, 192, 218, 630-631, 638-649
Office of Minority Health (OMH), 181,
192, 218, 420
Office of the Secretary, 385-386
standards for culturally and
linguistically appropriate services,
182-183
Substance Abuse and Mental Health
Services Administration
(SAMHSA), 390-391
U.S. Department of Housing and Urban
Development (HUD), 99
Housing Discrimination Study, 99
U.S. Department of Justice, 653-654
Bureau of Justice Statistics, 654
Civil Rights Division, 654
Office for Civil Rights (OCR), 656
U.S. Department of the Interior, 530-531
U.S. Department of Veterans Affairs, 391,
418. See also Veterans
Administration (VA) health
system
Centers for Excellence, 391
U.S. Department of War, 530
U.S. Office of Juvenile Justice and
Delinquency Prevention (OJJDP),
101
U.S. population, growing diversity of, 181
U.S. Public Health Service (PHS), 531
U.S. Supreme Court decisions, 107,121,
158-159, 693
Utilization managers, as discretionary
actors, 130
Utilization review and practice guidelines,
716-717
INDEX
V
Vaccination, 71-74, 374-375
Van Ryn, Michelle, 635
Veterans Administration (VA) health
system, 56-57, 71, 79, 85,136-137,
148-150, 430, 438, 530
Vietnamese Americans, 194, 479
Vietnamese language, 90
W
War on Poverty, 531
Washington Civil Rights Initiative, 122
WASP. See White Anglo-Saxon Protestant
Westat Corporation, 278
White, Charles, 501
White Anglo-Saxon Protestant (WASP), 483
White Christians, 498
White non-Hispanic ethnic groups, 482483
Whites, 34
defined, 34, 474, 526
Wickline v. State of California, 684n
Williams, David, 621
W.K. Kellogg Foundation, 421
Women's health services, 376-379
World Health Organization, 464
World War I, 504
World War II, 474, 486, 495, 506
Worldview, defined, 490, 526
X
X-ray tomography, 129
Representative terms from entire chapter:
ethnic disparities
