health systems. Research attention is desirable across multiple dimensions of health care.
Geographic Variation Why care varies across areas is poorly understood. Some variation may be due to less adequate services in poor areas that are predominantly minority. However, geographic variation that is not rooted in any racial or ethnic factor could still produce racial and ethnic differences in care. Different ways to define geographic areas, different patterns across areas for various medical procedures, and the complex and changing settlement patterns for racial and ethnic groups all complicate the research challenge.
Health Care Institutions The specific characteristics of health care institutions and systems that affect racial and ethnic differences in care require attention. Financial, structural, and institutional factors need consideration, taking into account features of medical procedures, such as their cost, and the degree to which medical consensus exists about particular treatments.
Provider Behavior and Stereotypes Whether, and if so how, provider decisions about treatment are influenced by stereotypes requires consideration. Negative stereotypes and the unrecognized discrimination connected with them could contribute to systematic bias in the delivery of medical care. Evidence that this actually happens, and that medical decisions are sometimes inappropriate for this reason, does not exist.
Patient Compliance Racial and ethnic differences in acceptance of therapies and compliance with prescribed regimens deserve clarification. Differences across groups are unclear and may depend on the specific medical conditions, procedures, and prescriptions. The reasons for any differences also require study—whether they are due to differences in the way patients are treated or advised, in the cultural background of each patient, or in other factors.