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OCR for page 739
Index
A African Moors, 498
Agassiz, Louis, 501
AAHP. See American Association of Health Age-adjusted death rates
Plans for all causes of death by race and
AAMC. See Association of American Hispanic origin, 82
Medical Colleges for selected causes of death by race and
AAPI. See Asian Americans and Pacific Hispanic origin, 83
Islanders Agency for Healthcare Research and
AAPIHF. See Asian American and Pacific Quality (AHRQ), 219, 223, 226,
Islander Health Forum 235, 243, 386, 420, 659, 711
Aboriginal people (Australia), 441 Assessment of Quality Improvement
Access Strategies in Health Care, 386
to data sources, 229 Measures of Quality of Care for
to medical treatment, 645-647 Vulnerable Populations, 386
to services, 143-144 Translating Research into Practice, 386
Acculturation, defined, 464, 475, 521 Understanding and Eliminating
Acute myocardial infarction (AMI), 44, 46, Minority Health Disparities
426-428, 431 Initiative, 386
Administrative choices AHRQ. See Agency for Healthcare
in the design of managed care systems, Research and Quality
691-693 Alaska Native Colorectal Cancer Education
in establishing conditions of Project, 387
participation and quality of care Alaska Native Tribal Health Consortium,
management, 690-691 534n
in separate SCHIP programs, 689-690 Alaska Natives, 34, 85, 89, 477-478
African Americans, 2, 34, 84-85, 278, 475- defined, 34, 522
477. See also Blacks Albert Einstein School of Medicine, 634
defined, 32n, 34 Alexander v. Sandoval, 158, 641-642, 656, 661-
and the “over-diagnosis” of 662, 693n
schizophrenia, 612-613 Alien, Sedition, and Naturalization Acts, 459
739
OCR for page 740
740 INDEX
AMA. See American Medical Association Asthma, 62-63, 296-297
American Association of Health Plans Attitude of healthcare providers, 400-401
(AAHP), 218 Australian Aboriginal, defined, 474
American College of Surgeons, 108 Availability of services, 143-144
American Health Dilemma, An, 489 Aversive racism, 494, 614-616
American Indian and Alaskan Native Awareness of racial and ethnic differences
Planning Grants, 391 in healthcare
American Indians, 34, 85, 89, 477-478 increasing among healthcare providers,
defined, 34, 474, 522 6, 20, 124
American Medical Association (AMA), 107- increasing among the general public and
108, 273, 419, 503, 505, 507, 659 key stakeholders, 6, 20, 124
Council on Medical Education, 107 AZT medication, 436
American Nursing Association, 203
American Public Health Association, 609
B
American racial and ethnic relations, 458-
460
Bakke decision, 121
AMI. See Acute myocardial infarction
Balanced Budget Act of 1997, 683, 689n
Amputations, 74
Barriers for immigrants, 660
Analgesia, 64-66, 290-295
Bayer Institute, 196
Analgesic medication, 326-327
Bayesian physicians, 167-168
differential levels of prescription of, 11
Becker, Howard, 599
Ancient origins, 497-498
2002 Behavior Risk Factor Surveillance
Angina, 165
System, 387-388
Angiography and angioplasty, 137, 427, 434
Bernier, François, 499
Anglo-Protestants, 471, 483
BIA. See Bureau of Indian Affairs
defined, 522
Bias
Anglo-Saxon, defined, 522
defined, 522
Antebellum period, 471, 501
of efficacy, 603-604
Anti-discrimination thesis, 722
in physician decision-making, 632-637
Anti-Semitism, 486
in social stereotypes and attitudes, 169-
API. See Asian Americans and Pacific
171
Islanders
Bill of Rights, 459
Archaic medical system, 498
Biological differences, that may justify
defined, 522
differences in receipt of care, 138-
Argon laser trabeculoplasty surgery, 71
139
Aristotle, 497-498
Biometric testing, 504
Art of Care Scale, 613
Blacks, 34, 475-477. See also African
Asian American and Pacific Islander
Americans
Health Forum (AAPIHF), 284
defined, 32n, 34, 474, 522
Asian Americans and Pacific Islanders
Blumenbach, Johann Fredreich, 500
(API), 34, 85-86, 89-90, 478-480
Boren Amendment, 675n
defined, 34, 474, 522
Boys in White, 599
Assessment of Quality Improvement
British Medical Journal, 441
Strategies in Health Care, 386
Brown v. Board of Education, 107
Assimilation, 475, 522
Buffon, George-Louis Leclerc, 500
identificational, 523
Bureau of Indian Affairs (BIA), 462, 488,
Association of American Medical Colleges
531-532
(AAMC), 121, 421
Bureau of Justice Statistics, 654
Assumptions about racial and ethnic
Bureau of Primary Health Care, 389
disparities in healthcare, 3-4, 30-
Quality Center, 389
35
Bureau of Prisons, 530
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741
INDEX
Bureau of the Census. See U.S. Census Catheterization, 135, 163
Bureau Causality, social structural egalitarian
Bystanders as interpreters, 143 views of, 732-734
Cautions, about health systems issues and
the complexities of mental health
C phenomena, 618-619
CCHCP. See Cross Cultural Health Care
CABG. See Coronary artery bypass graft Program
CAHPS. See Consumer Assessment of CD-ROM-based instructional material, 18,
Health Plans; Consumer
196-197, 387
Assessment of Health Plans CDC. See Centers for Disease Control and
Survey Prevention
California Children and Families
CEA. See Carcinoembryonic antigen testing
Commission, 226 Centers for Disease Control and Prevention
California Civil Rights Initiative, 122 (CDC), 226, 243, 385-388
California Department of Health Services,
Alaska Native Colorectal Cancer
225-226 Education Project, 387
California Endowment, 226 2002 Behavior Risk Factor Surveillance
California Health Interview Survey (CHIS),
System, 387-388
225-226 Hispanic Colorectal Cancer Outreach
California Healthcare Interpreters and Education Project, 387
Association (CHIA), 193
National Breast and Cervical Cancer
California Public Employees Retirement Early Detection Program
System (CalPERS), 699n (NBCCEDP), 387
California Regents decision, 122
National Comprehensive Cancer Control
Calman, Neil, 634 (CCC) Program, 387
CalPERS. See California Public Employees National Program of Cancer Registries,
Retirement System
387
Cambodian language, 89 National Training Center, 387
Cambridge Health Alliance, 391 prostate cancer screening behaviors, 387
Camper, Petrus, 500
Racial and Ethnic Approaches to
Cancer, 52-57, 298-305, 431-433 Community Health, 386-387
racial and ethnic differences in, 5 Centers for Medicare and Medicaid
CAP. See Community Access Program
Services (CMS), 222, 224, 388
Capitation, and DRGs, 713-715 Excellence Centers to Eliminate Ethnic/
Carcinoembryonic antigen (CEA) testing, 54 Racial Disparities, 388
Cardiac medication, 30
Reducing Health Care Disparities
Cardiopulmonary resuscitation (CPR), 71 National Project, 388
Cardiovascular care, racial and ethnic Centers of Excellence, 386, 391
differences in, 5
Cerebrovascular disease, 57-58, 328-331
Cardiovascular disease, 39, 42-52, 306-325, Cesarean deliveries, 67
328-329 Changes
studies of the role of financial and
in concepts of race and ethnicity, 490-496
institutional characteristics, 45-48 in the ethnicity and race of medical
studies to assess appropriateness of students, physicians, nurses, and
services, 48-49
healthcare staff, 621
studies using administrative databases, in the healthcare arena, 534-535
42-45 CHCs. See Community health centers
Carter, Michael, 646, 663
CHEF. See Catastrophic Health Emergency
CASS. See Coronary Artery Surgery Study Funds
Catastrophic Health Emergency Funds Chen, Jersey, 633
(CHEF), 541-542, 549
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742 INDEX
CHF. See Congestive heart failure CLAS. See Culturally and linguistically
CHIA. See California Healthcare appropriate services, standards
Interpreters Association for healthcare
Children’s health services, 68-69, 330-335 Class, defined, 522
Chinese Americans, 93-94 Clinical caretakers as discretionary actors,
Chinese Exclusion Act, 459 128-130
Chinese language, 89 Clinical decision-making and the roles of
CHIS. See California Health Interview stereotyping, uncertainty, and
Survey bias, 236-237
CHS. See Contract Health Service Clinical discretion, 125-130
Cincinnati Children’s Hospital Center, 197 clinical caretakers as discretionary
Civil Rights Act, 157, 188, 221, 507, 628-631, actors, 128-130
668, 679 patient as discretionary actor, 128
Title VI, 157, 159, 188, 192, 221, 628-631, subjectivity and uncertainty, 128-130
637-641, 668, 679 subjectivity and variability, 128
Title VII, 631 utilization managers as discretionary
Civil rights dimension of racial and ethnic actors, 130
disparities in healthcare, 626-663 Clinical encounters, 160-179
defining discrimination, 629-632 healthcare provider prejudice or bias,
discrimination as a root cause of 162-174
disparities, 632-649 medical decisions under time pressure
using civil rights strategies to assist in with limited information, 161-162
eliminating racial and ethnic mistrust and refusal, 174-175
disparities, 649-663 patient response, 174-175
Civil Rights Division, 654 Clinical uncertainty, 9, 167-169
Civil rights enforcement, 15, 187-188 Clinician “bias,” 611-616
Civil Rights era in healthcare, 506 Clinton, William, 626, 677, 692, 705
Civil Rights Movements, 505 “Closing the Health Gap” campaign, 123
Civil rights strategies CMS. See Centers for Medicare and
developing a comprehensive language Medicaid Services
access agenda, 657-660 Cobb, W. Montague, 505
developing capacity and infrastructure COGME Reports, 118, 120
to address critical civil rights Cognitive shortcuts, in physician decision-
questions in managed care, 662 making, 11, 160-161
fixing the Sandoval decision, 661-662 Cold War, 506
identifying and eliminating other Collecting data on healthcare access and
barriers for immigrants, 660 utilization, by patient race,
mandating the collection of data on race, ethnicity, socioeconomic status,
ethnicity, and language of and primary language, 21-22, 233
preference, 650-655 Colonial period, 501
performing a civil rights self-assessment, Columbus, 465
662-663 Commercial capitalism and the slave
preventing discrimination through society, 466-467
education of providers and Commissioned papers, 273
patients, 660-661 Commonwealth Fund, 219, 226, 421, 574
strengthening the federal, state, and Communication and clinical decision-
private healthcare, 655-657 making, sociocultural differences
using to assist in eliminating racial and between patient and provider
ethnic disparities, 649-663 influencing, 214
Civil War, 471, 501-502 Communication style, patient satisfaction
discrimination during, 103 and health outcomes, 574-575
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743
INDEX
Community Access Program (CAP), 388-389 impact on racial and ethnic disparities in
Community Action Grant Program, 390 healthcare, 699-721
Community and Migrant Health Centers managed competition, 705-706
Program, 112 racial and ethnic disparities, 706
Community health centers (CHCs), 112, supply-side approaches, 703-705, 712-718
114, 506 Cowan v. Myers, 678n
impact on healthcare in minority and CPR. See Cardiopulmonary resuscitation
medically underserved areas, 112, Criminal justice, racial discrimination in,
114 100-101
Community Health Representatives, 548 Criteria for literature review, 40-41
Community health workers, 17-18, 21, 193- ranking of studies, 41
195 review papers, 41
increasing racial and ethnic minorities’ search keywords, 40
access to healthcare, 195 “threshold” criteria, 40
Compacting, improvement in quality of Critical analysis of the culture of medicine,
care, 543-545 620-621
Competitive racism, 493 Cross-cultural approach, 206-207
Concentration of poverty, in 100 largest Cross-cultural communication, links to
U.S. cities, 688 racial/ethnic disparities in
Concepts of race and ethnicity, 490-496 healthcare, 200-201
on ethnic groups, 495-496 Cross-cultural curricula, in undergraduate
on racial groups and hierarchies, 490-493 medical education, 202
racial models as tools for analysis and Cross-cultural education
understanding, 493-495 challenges and opportunities, 211-212
Congestive heart failure (CHF), 72 cultural sensitivity/awareness approach,
Constructionist thinking, 496 203-204
defined, 522 developing the field, 211
Consumer Assessment of Health Plans evaluation, 209-211
Survey (CAHPS), 69, 223, 711 focus on attitudes, 203-204
Consumer information, 711-712 focus on knowledge, 204-206
Consumer Perspective, Clinical Guidelines focus on skills, 206-207
for Providers, and Provider and foundation and emergence of, 201-203
System Competencies for in the health professions, 19-20, 199-214
Training, 390 improving healthcare professionals’
Contract Health Service (CHS), 536, 539, ability to provide quality care, 214
541-543, 549 multicultural/categorical approach, 204-
Contracting, improvement in quality of 206
care, 543-545 provider perspectives, 211
Control, over key clinical characteristics, teaching methods and opportunities,
380-383 207-209
Cook v. Ochsner Foundation Hospital et al., in the training of health professionals,
682n 214
Cooper-Patrick, Lisa, 635 Cross Cultural Health Care Program
Coronary artery bypass graft (CABG), 30, (CCHCP), 385
43-49, 137-140, 149-150, 425, 427- Cuban Americans, 87
430 Cultural sensitivity/awareness approach,
Coronary artery disease, 425-431 203-204
Coronary Artery Surgery Study (CASS), 419 Culturally and linguistically appropriate
Cost containment strategies, 700-706 services (CLAS), standards for
demand-side approaches, 701-702, 706- healthcare, 181-183, 192
712
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744 INDEX
Culturally appropriate patient education data needs and recommendations, 232-
programs, increasing patients’ 234
knowledge of accessing care and data sources to assess healthcare
participating in treatment disparities, 223-226, 271-284
decisions, 198 federal role in racial, ethnic, and primary
Culture language health data, 219-223
defined, 522 Home Mortgage Disclosure Act
expression of mental illness, 614 (HMDA), 651-653
“Culture, Communication, and Health” models of measuring disparities in
course, 209 healthcare, 226-232
Culture of medicine, 594-625 in mortgage lending, 651-653
addressing healthcare disparities obstacles to racial/ethnic data collection,
through the training of healthcare 217-219
professionals, 606-611 standardizing, 215
African Americans and the “over- Data Council, 221
diagnosis” of schizophrenia, 612- Data needs and recommendations, 232-234
613 Data sources to assess healthcare
bias of efficacy, 603-604 disparities, 223-226, 271-284
case analyses of disparities in mental California Health Interview Survey
health services, 611-612 (CHIS), 225-226
cautions about health systems issues and commissioned papers, 273
the complexities of mental health Consumer Assessment of Health Plans
phenomena, 618-619 Survey (CAHPS), 223
“clinician bias,” “aversive racism,” and focus groups and roundtable
misdiagnosis, 614-616 discussions, 278, 284
culture and the expression of mental Health Plan Employer Data and
illness, 614 Information Set (HEDIS), 220, 225
disruptions in the medical machine, 600- literature review, 271, 273
603 Medical Expenditure Panel Survey
insights from physicians in academic (MEPS), 223-224
teaching hospitals, 598-600 Medicare Current Beneficiary Survey
needed research, 619-621 (MCBS), 224-225
political correctness, the medical Medicare’s Enrollment Database, 224
machine and the meaning of bias, public workshops, 273-277
604-606 study committee, 271
race, perceptions of violence, study components and timeline, 272
involuntary commitment, and technical liaison panels, 278-283
diagnosis of schizophrenia, 616- “De-fragmentation” of healthcare financing
618 and delivery, 13, 182-184
Current Population Survey, 463 Death Registration Area (DRA) system, 488
Cuvier, Georges, 500-501 Demand-side approaches, 701-702, 706-712
consumer information, 711-712
patient cost sharing, 706-711
D Demographics of healthcare providers, 114-
116. See also Patient
Daniels, Norman, 727
sociodemographics; Physician
Darwin, Charles, 501 sociodemographic characteristics
Darwinism, 504 distribution of registered nurse
Data collection and monitoring, 21-22, 215-
population in geographic areas by
234 racial/ethnic background, 117
assessment of federal policies and nurses, 116
practices, 220-221
physicians, 114-115
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745
INDEX
Demography, defined, 465, 522 DRGs. See Diagnosis-related groups
Department for the Diseases of Children, DSM-III, 615
484 DSM-IV, 608
Destabilization, patchy, 508 Duke University Medical Center, 140, 429
DHHS. See U.S. Department of Health and Dyads, race-discordant, 574
Human Services
Diabetes, 64, 336-337
E
Diagnoses
cancer, 431-433
Economics, role of, 395
coronary artery disease, 425-431
ED. See Emergency department services
general medical and surgical care, 422-
EEOC. See Equal Employment Opportunity
425
Commission
HIV/AIDS, 437-439
Egalitarian theories, 726-728
implications for change, 442-444
Elder Care Initiative, 389
improper, 397-398
Emergency department (ED) services, 153
overall pattern of evidence, 439-440
Emergency Detention Order, 546
racial and ethnic disparities in care, 441-
Emergency Medical Treatment and Active
442
Labor Act (EMTALA), 156-157
renal disease and kidney
Emergency services, 71-74, 336-339
transplantation, 435-437
Employment, racial discrimination in, 100
review of the evidence and a
EMTALA. See Emergency Medical
consideration of causes, 417-454
Treatment and Active Labor Act
stroke, 434-435
Enalapril, racial and ethnic differences in
Diagnosis-related groups (DRGs), 703, 713-
responses to, 7, 138
715
End-stage renal disease (ESRD), 45, 58-60,
Differences, defined, 126, 159
68, 435-437
Directory of Health and Human Services Data
English Americans and Anglo-Protestant
Resources, 223
culture, 483-484
Disadvantaged neighborhoods, 100
English common law, 458
Discrimination
English proficiency, limited, 640-642
concerns unique to immigrant
Enlightenment principles, 458
populations, 647-649
Epidemics, 470
defined, 4, 159-160, 475, 523, 629-632
Equal Employment Opportunity
explaining racial and ethnic disparities
Commission (EEOC), 650
in health, 637
Equality, 458
institutional, 95
Erasistratos, 498
preventing through education of
ESRD. See End-stage renal disease
providers and patients, 660-661
Ethical analysis of racial and ethnic
Discrimination as a root cause of
disparities in healthcare
disparities, 632-649
implications for physicians, nurses, and
literature review, 632-637
other providers of health care
Title VI enforcement history, 638-649
services, 737
Disparities, defined, 3-4, 32, 126, 159
the neutrality thesis and the anti-
Disruptions, in the medical machine, 600-
discrimination thesis, democratic
603
political theory, 728-729
Diversity, of U.S. population, growing, 181
relevance of causal stories, 729-736
Diversity Rx, 123
when and how they matter, 722-738
DoD. See U.S. Department of Defense
Ethnic American, defined, 523
Dominant group, defined, 458, 523
Ethnic categories for federal data
Dominative racism, 494
Hispanic or Latino (“Spanish origin”), 34
DRA. See Death Registration Area system
not Hispanic or Latino, 34
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746 INDEX
Ethnic groups, 495-496 Executive Office of the President, 384
defined, 523 Office of Management and Budget, 384
Ethnicity, defined, 462, 474, 523 Executive Orders, 657
Eugenics, 504 Eye care, 71-74, 338-341
European American, defined, 523
Evidence-based cost control, 15-16, 189-190
F
Evidence-based guidelines, promoting the
consistency and equity of care
Fadiman, Anne, 605
through the use of, 16, 20, 189-190
Failed reform and corporate takeover, 508
Evidence of race-concordance
Fair Housing Act, 98-99
consequences for the
Federal Employees Health Benefits Plan
communication process, 574
(FEHBP), 699n
Evidence of racial and ethnic disparities in
Federal Financial Institutions Examination
healthcare, 5-6, 38-77
Council (FFIEC), 652
analgesia, 64-66, 290-295, 326-327
Federal healthcare financing programs
asthma, 62-63, 296-297
supported through direct public
cancer, 52-57, 298-305
funding. See also Medicaid;
cardiovascular disease, 39, 42-52, 306-
Medicare; State Children’s Health
325, 328-329
Insurance Program (SCHIP)
cerebrovascular disease, 57-58, 328-331
health disparities and Medicare and
children’s health services, 68-69, 330-335
Medicaid administration, 681-693
diabetes, 64, 336-337
health problems and long-term care
emergency services, 71-74, 336-339
needs of minority and non-
extent of, 76-77
minority individuals, 671
eye care, 71-74, 338-341
issues in the design, structure, and
gallbladder disease, 71-74, 340-341
administration of, 664-698
HIV/AIDS, 61-62, 342-343
overview, 667-673
maternal and infant health, 66-68, 344-
poverty rates among minority and non-
349
minority individuals, 672
mental health services, 69-71, 348-353
racial and ethnic minority Americans as
needed research, 75-76
a share of the elderly population,
other clinical and hospital-based
671
services, 71-74
supplemental insurance coverage among
patient perceptions, 71-74, 358-359
minority and non-minority
peripheral vascular disease, 71-74, 352-
Medicare beneficiaries, 672
355
Federal-level and other initiatives to
pharmacy services, 71-74, 352-355
address racial and ethnic
physician perceptions, 71-74, 354-359
disparities in healthcare, 235, 384-
radiographic services, 71-74, 360-361
391
rehabilitative services, 66, 360-363
Cambridge Health Alliance, 391
renal transplantation, 58-60, 362-365
Department of Health and Human
use of services and procedures, 71-74,
Services (DHHS), 384-391
364-377
Department of Veterans Affairs, 391
vaccination, 71-74, 374-375
Executive Office of the President, 384
women’s health services, 376-379
Federal policies and practices, assessment
EXCEED. See Excellence Centers to
of, 220-221
Eliminate Ethnic/Racial
Federal Register, 640, 651
Disparities
Federal role in racial, ethnic, and primary
Excellence Centers to Eliminate Ethnic/
language health data, 219-223
Racial Disparities (EXCEED), 388
Federally Qualified Health Center, 536
Exclusion, defined, 475
Fee-for-service health systems, 75, 705
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747
INDEX
FEHBP. See Federal Employees Health Glazer, Nathan, 496
Benefits Plan Great Chain of Being, 497
FFIEC. See Federal Financial Institutions Great Depression and World War II, 505
Examination Council Greco-Roman world, 498
Financial incentives in healthcare, 16-17, GSS. See General Social Survey
190-191 Guidance on Aggregation and Allocation
Financing challenge, critical, 658-659 of Data on Race for Use in Civil
Flexner, Abraham, 105, 458 Rights Monitoring and
Focus Enforcement, 384
on attitudes, 203-204
on knowledge, 204-206
H
on skills, 206-207
Focus group findings about racial and
Hafferty, Fred, 599
ethnic disparities in healthcare,
Harlem Hospital, 661
392-405
Harvard Medical Practice Study, 598
identifying racial and ethnic
Harvard Medical School, 599, 633
discrimination, 398-402
Harvard School of Public Health, 489, 633
inclusion of and respect for culture in
HCFA. See Health Care Financing
healthcare experiences, 403-405
Administration
institutional discrimination in
Health, defined, 523
healthcare, 402-403
“Health Accountability 36,” 226-228
stories of racial discrimination in
Health Care Divided, Race and Healing a
healthcare practice, 392-398
Nation, 638
Focus groups, roundtable discussions, 278,
Health Care Financing Administration
284
(HCFA), 222-223, 389, 418, 420,
Folk illnesses and healing practices, 205
436, 536-537
Ford Foundation, 421
database of, 423
Fragmentation of healthcare systems, 147-
Health deficit, defined, 525
148
Health disparities and Medicare and
along socioeconomic lines, avoiding, 13,
Medicaid administration, 548,
20, 184
681-693
Freedmen’s Bureau, 502-503
choices in establishing conditions of
participation and quality of care
management, 690-691
G
choices in provider payment, 687-689
Galen, 498-499 choices in setting eligibility standards
Gallbladder disease, 71-74, 340-341 and enrollment arrangements,
Gamble, Vanessa, 634 685-687
GAO. See General Accounting Office choices in the design of managed care
Geiger, Jack, 627n, 660 systems, 691-693
General Accounting Office (GAO), 687 concentration of poverty, in 100 largest
General medical and surgical care, 422-425 U.S. cities, 688
General Social Survey (GSS), 93 conditions of physician participation,
Geographic factors, 117, 144, 286, 488n 683-684
George Washington University Center for issues underlying racial disparities, 684-
Health Services Research and 685
Policy, 690 separate SCHIP programs, 689-690
German Americans, 484 Health insurance coverage. See also
German Dispensary, 484 Insurance status of racial and
German hospitals, 484 ethnic groups
Glaucoma, 71 among Latino subgroups, 88
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748 INDEX
by Asian-American and Pacific Islander Healthcare disparities
subgroups vs. whites, 86 addressing through the training of
by race and ethnicity, 679-680 healthcare professionals, 606-611
Health Insurance Portability and among non-African American minority
Accountability Act (HIPAA), 217, groups, 240
220, 222, 243 improving research on, 242-243
Health maintenance organizations (HMOs), sources of, 125-130
54, 63, 75, 704-705, 715-716 Healthcare dollars, 536-537
mandatory enrollment in, 8 Healthcare environment, 80-124
staff-model, 115 brief history of legally segregated
Health Plan Employer Data and healthcare facilities, 103-108
Information Set (HEDIS), 220, 225, contemporary de facto segregation, 103-108
231, 234, 711 health status of racial and ethnic
Health plan payments minority populations, 81-83
to primary care physicians, 704 healthcare professions workforce in
to specialists, 704 minority and medically
Health plans, disclosing clinical protocols underserved communities, 114-
of, 16 120
Health professionals, increasing the historical determinants of contemporary
proportion of underrepresented minority health professions
U.S. racial and ethnic minorities workforce, 105-108
among, 14, 20, 186 historical overview of healthcare
Health Resources and Services delivery for racial and ethnic
Administration, 385, 388-389 minority patients, 102-103
Community Access Program (CAP), 388- insurance status of racial and ethnic
389 minority populations, 83-87
Measuring Cultural Competence in linguistic barriers of racial and ethnic
Health Care Delivery Settings, 388 minority populations, 87-90
Oral Health Initiative, 389 participation of racial and ethnic
Provider’s Guide to Quality and Culture, minorities in health professions
389 education, 120-123
Health Security Act, 705 racial attitudes and relations, 91-95
Health services, defined, 31 racial discrimination, 95-101
Health status of racial and ethnic minority relationship to broader racial attitudes
populations, 81-83 and discrimination, 6-7, 101-102
age-adjusted death rates for all causes of settings in which racial and ethnic
death by race and Hispanic minorities receive healthcare, 108-
origin, 82 114
age-adjusted death rates for selected Healthcare facilities, producing unique
causes of death by race and scores for, 229
Hispanic origin, 83 Healthcare professions workforce in
Health system interventions, 15-18, 188-196 minority and medically
community health workers, 17-18, 193- underserved communities, 114-
195 120
evidence-based cost control, 15-16, 189- demographics of healthcare providers,
190 114-116
financial incentives in healthcare, 16-17, impact of international medical
190-191 graduates (IMGs) on the
interpretation services, 17, 191-193 workforce in minority
multidisciplinary teams, 195-196 communities, 116-120
Healthcare, defined, 31, 523 top 10 countries with highest proportion
of medical graduates, 119
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749
INDEX
Healthcare providers, 89-90 Hip fractures, 66
biases in social stereotypes and attitudes, Hippocratic Oath, 497-498
169-171 Hispania, 480
clinical uncertainty, 167-169 Hispanic Americans, 87-88, 480-482
consequences of stereotypes, 171-172 defined, 32n, 34, 463, 523
functions of stereotypes and attitudes, 169 subgroups, 482
prejudice, 10-11, 162-174 Hispanic Colorectal Cancer Outreach and
provider beliefs and stereotypes, 169 Education Project, 387
stereotypes and healthcare disparities, Hispanic Medical Association (HMA), 421
172-174 Historical determinants, of contemporary
Healthcare services, defined, 31 minority health professions
Healthcare settings, 400 workforce, 105-108
influence on care for minority patients, Historical perspective, on inequities and
237-239 bias, 496-497
Healthcare systems-level factors, 8-9 Historical thinking, 496
Healthcare systems-level variables, 140-159 History of racial and ethnic disparities in
availability and access to services, 143- healthcare, 102-103, 455-527
144 American Indians or Alaska Natives,
fragmentation of healthcare systems, 477-478, 528-534
147-148 American racial and ethnic relations,
language barriers, 141-143 458-460
legal and regulatory policy and Asian Americans or Pacific Islanders,
healthcare disparities, 155-159 478-480
managed care revolution, 150-154 Blacks or African Americans (not of
maneuvering through clinical Hispanic origin), 475-477
bureaucracies, 144-145 changing concepts of race and ethnicity,
referral patterns and access to specialty 490-496
care, 145-146 dynamics of the U.S. racial and ethnic
shedding some negative aspects of the group interaction, 473-475
past, 508-510 English Americans and Anglo-Protestant
supply-side cost containment and culture, 483-484
demand for clinical services, 154- German Americans, 484
155 Hispanics, 480-482
U.S. Department of Defense and immigration, racial and ethnic groups,
Veterans Administration health and healthcare, 464-465,
healthcare systems, 148-150 470-473
Healthcare workforce, 80 Irish Americans, 485
“Healthy Families” programs, 90 Italian Americans, 485-486
Healthy People 2000, 226 Jewish Americans, 486
Healthy People 2010, 37, 385 North American health and health care,
Heckler, Margaret, 487 466-469
HEDIS. See Health Plan Employer Data and Polish Americans, 486-487
Information Set racial and ethnic data collection and
Henry J. Kaiser Family Foundation, The, definitions, 460-464
123, 421 racial and ethnic health and healthcare
Herophilos, 498 disparities and their
Herzog, Maximillian, 484 documentation in the U.S., 487-
HHS. See U.S. Department of Health and 489
Human Services white non-Hispanic ethnic groups, 482-
HHS-wide initiatives, 384-385 483
Hill-Burton Act, 631, 682n HIV/AIDS, 61-62, 342-343, 437-439
OCR for page 754
754 INDEX
N
Meriam Report, 477, 531
Merton, Robert K., 599
NAACP, 505
Metaracism, 494
NACHM. See National Advisory
Mexican Americans, 87, 614
Commission on Health
MI. See Myocardial infarction
Manpower
Middle Ages, 498-499
NALS. See National Adult Literacy Survey
Minority, defined, 524
Namias, Barbara, 536
Minority Health, 528
National Adult Literacy Survey (NALS),
Minority HIV/AIDS initiative, 384-385
571
Minority patients
National Advisory Commission on Health
mistrust and experiences of
Manpower (NACHM), 118
discrimination, 135-136
National Alliance for Hispanic Health, 387
preferences regarding providers and
National Board of Medical Examiners, 209
racial concordance, 132-135
National Breast and Cervical Cancer Early
Minority stereotype, defined, 524
Detection Program (NBCCEDP),
Minority youth, in the juvenile justice
387
system, 100-101
National Cancer Institute (NCI), 53, 226
“Misanthropy Scale,” 209
National Center for Vital and Health
Misdiagnosis, 614-616
Statistics, 81
Mistrust, 174-175
National Center on Minority Health and
MMIA. See Massachusetts Medical
Health Disparities (NCMHD),
Interpreter Association
390, 420, 597
Model minority stereotype, defined, 524
National Committee for Quality Assurance
Models for measuring disparities in
(NCQA), 225, 227, 231, 233-234,
healthcare, 226-232
711
“Health Accountability 36,” 226-228
State of Managed Care Quality report, 231
integrated approaches, 227, 229-231
National Committee on Vital and Health
reporting of racial and ethnic disparities
Statistics (NCVHS), 219, 222
using existing data sets, 231-232
National Comprehensive Cancer Control
Monitoring healthcare disparities, 241
(CCC) Program, 387
Monitoring progress, toward elimination of
National Consumer Assessment of Health
healthcare disparities, 21-22, 234
Plans (CAHPS), 69
Moon, Marilyn, 667, 694
National Council of Urban Indian Health,
Moral foundations, 724-729
536
Mortgage lending, racial discrimination in,
National Council on Interpretation in
96
Healthcare, 193
Morton, Samuel George, 501
National Diabetes Program, 389
MOS. See Medical Outcomes Study
National Health Interview Surveys, 429
Mt. Sinai Hospital, 486
National Health Law Program (NHeLP),
Multicultural/categorical approach, 204-
219-222, 656
206
National Health Service (NHS), 112, 441
Multidisciplinary treatment and preventive
National Hospital Discharge Survey
care teams, implementing, 18, 21,
(NHDS), 43
195-196
National Indian Council on Aging
Multinational capitalism, advanced, 468-
(NICOA), 537
469
National Indian Health Board, 531, 534, 537
Muslim culture, 205, 498
National Institute of Mental Health
Myocardial infarction (MI), 43-45, 59, 71,
(NIMH), 617
134, 137
Epidemiological Catchment Area
Myrdal, Gunnar, 417, 444
studies, 617
OCR for page 755
755
INDEX
National Institutes of Health (NIH), 63, 243, NIH. See National Institutes of Health
385, 389-390, 420, 597, 600 NIMH. See National Institute of Mental
National Center on Minority Health and Health
Health Disparities, 390 NMA. See National Medical Association
strategic research agenda on health NNRTI. See Nonnucleoside reverse
disparities, 389-390 transcriptase inhibitors
National League for Nursing, 203 Noeggerath, Emil, 484
National Medical Association (NMA), 108, Non-hospital facilities, site of care in, 111
421, 503, 643, 662 Non-physician health professionals, 239-
National Program of Cancer Registries, 387 240
National Quality Forum (NQF), 216, 219, 226 Nonnucleoside reverse transcriptase
National Training Center, 387 inhibitors (NNRTI), 61
National Vital Statistics report system, 226 NQF. See National Quality Forum
Native Hawaiian, 34 Nurses, 116
defined, 34
Naturalization Law of 1790, 459
O
Navajo language, 89
NBCCEDP. See National Breast and
Obstacles to racial/ethnic data collection,
Cervical Cancer Early Detection
217-219
Program
OCR. See Office of Civil Rights
NCI. See National Cancer Institute
OEO. See Office of Economic Opportunity
NCMHD. See National Center on Minority
Office for Civil Rights (OCR), 15, 157, 187,
Health and Health Disparities
192, 218, 385-386, 630-631, 638-
NCQA. See National Committee for
649, 656
Quality Assurance
Limited English Proficiency Guidelines,
NCVHS. See National Committee on Vital
695
and Health Statistics
Office of Economic Opportunity (OEO),
“Negro medical ghetto,” 503, 505
531
Neighborhood health centers (NHCs), 506
Office of Indian Affairs, 530
Neighborhoods, systematically
Office of Management and Budget, 32, 227,
disadvantaged, 100
234, 384, 461, 463
NEJM. See New England Journal of Medicine
Guidance on Aggregation and
Neutrality thesis, 722
Allocation of Data on Race for
Neutrality thesis and the anti-
Use in Civil Rights Monitoring
discrimination thesis
and Enforcement, 384
democratic political theory, 728-729
Standards for the Classification of
differences between, 723-724
Federal Data on Race and
Egalitarian theories, 726-728
Ethnicity, 32
Libertarian theories, 725-726
Office of Minority Health (OMH), 181, 192,
moral foundations for, 724-729
218, 385, 420
New England Journal of Medicine (NEJM),
Resource Center, 385
419, 594, 606, 632
Office of the Secretary of DHHS, 385-386
New Jersey State Police, 654
Cross Cultural Health Care Program, 385
New York Medical College, 484
Healthy People 2010, 37, 385
Newsday, 646
Office for Civil Rights (OCR), 385-386
NHCs. See Neighborhood health centers
Office of Minority Health (OMR), 385
NHDS. See National Hospital Discharge
Office on Women’s Health, 385
Survey
Ohio State University Medical Center, 197
NHeLP. See National Health Law Program
OJJDP. See U.S. Office of Juvenile Justice
NHS. See National Health Service
and Delinquency Prevention
NICOA. See National Indian Council on
OMH. See Office of Minority Health
Aging
OCR for page 756
756 INDEX
Opioid supplies, availability of, 8 evidence of race-concordance
Oral Health Initiative, 389 consequences for the
Other, the, 609 communication process, 574
“Overcompensation,” 134 implications for physician training and
Overuse of clinical services, by white patient activation to improve
patients, 139-140 patient-physician
communications within culturally
diverse populations, 575-577
P nature and consequences of broad
normative expectations, bias, and
Pacific Business Group on Health, 711 racial stereotyping by providers
Pacific Islander, 34 and patients, 556-557
defined, 34, 522
needed research, 577-579
Page Act of 1875, 459 physician role obligations and
Paired testing strategies, 188n medicine’s unwritten social
Pap smears, 194
contract, 556
Paperwork Reduction Act, 217 relationship between communication
Participation, of racial and ethnic style and patient satisfaction and
minorities in health professions
health outcomes, 574-575
education, 120-123 role and impact of patient
Participatory decision-making (PDM), 132, sociodemographics on medical
559, 572-574
communication, 562-572
Paternalistic racism, 493 role of cross-cultural training for
Patient- and system-level factors, 125-159 healthcare professionals, 579-580
Patient education programs, implementing,
role of physician sociodemographic
19, 21, 198 characteristics on the medical
Patient-level variables, 7-8, 131-140, 237 dialogue, 558-564
biological differences that may justify
scope of topic, 553-555
differences in receipt of care, 138- Patient sociodemographics
139 age, 565-567
minority patient mistrust and
gender, 565
experiences of discrimination, health status, 569-570
135-136 literacy, 570-572
minority patient preferences regarding
race and ethnicity, 562-565
providers and racial concordance, social class, 567-569
132-135 Patients
overuse of clinical services by white
appearance, 399
patients, 139-140 cost sharing by, 706-711
patient refusal of recommended as discretionary actors, 128
treatment, 136-138
economic/insurance status, 399-400
patients’ preferences, 131-135 education and empowerment, 18-19, 196-
role of preferences, treatment refusal, 198
and the clinical appropriateness of
perceptions, 71-74, 358-359
care, 7-8 preferences, 131-135
Patient-provider communication, 552-593 protecting, 14-15, 186-187
consequence of race concordance on
refusal of recommended treatment, 136-
patient reports of physician 138
participatory decision-making response by, 12, 174-175
(PDM) style and other aspects of
role and impact on medical
communication, 572-574 communication, 562-572
correlates of communication, 557-558
OCR for page 757
757
INDEX
Patients and Healers in the Context of Culture, Practice arrangements, of minority
607 physicians, 621
PCP. See Pneumocystis carinii pneumonia Pre-Columbian and North American
PDM. See Participatory decision-making development, 466-467
Percutaneous transluminal coronary Preferences, defined, 4n
angiography (PTCA), 44-49, 139- Prejudice, defined, 524
140, 149-150 “Prejudice-related conflict,” 616
Peripheral artery disease, 74 Prescription services, 73
Peripheral vascular disease, 71-74, 352-355 Prichard, James Cowles, 501
Personally mediated racism, defined, 524 Primary care visits, made to primary care
Pew Health Professions Commission, 203 delivery sites by health insurance
Pharmacy services, 71-74, 352-355 payer and race/ethnicity, 113
PHS. See U.S. Public Health Service Professional interpretation services,
Physician “gag” clauses, banning, 14 increasing linguistic diversity in
Physician role obligations, medicine’s the U.S. requires increase in, 193
unwritten social contract, 556 Proficiency, limited, in English, 640-642
Physician sociodemographic characteristics Program successes redressing imbalances
gender, 559-560 in care, assessment of, 621
race and ethnicity, 558-559 Prostate cancer screening behaviors, 387
social class, 560-562 Protease inhibitors (PI), 61
Physicians, 114-115 Providers
perceptions by, 71-74, 354-359 beliefs and stereotypes, 169
role in the medical dialogue, 558-564 perspectives, 211
Physician’s fees, low, 712-713 Provider’s Guide to Quality and Culture,
PI. See Protease inhibitors 389
Pittsburgh Police Department, 654 PTCA. See Percutaneous transluminal
Plato, 497-498 coronary angiography
Pneumocystis carinii pneumonia (PCP), 61- Public Health Institute, 225
62 Public Health Service Act, 680
Pneumonia, 72 Public workshops, 273-277
Pocket guide and desk reference, 390 PUBMED database, 285
Polish Americans, 486-487 Puerto Rican Americans, 87
Political correctness, 604-606
Political economy, of cultural practices in
Q
medicine, 621
“Polygenism,” 501
Quality Compass database, 231
Populations. See also Current Population
Quality of care
Survey; Measures of Quality of
defined, 31
Care for Vulnerable Populations
received by tribal communities, 539-543
defined, 31
elderly, 671
growing diversity of U.S., 181
R
health status of, 81-83
immigrant, 647-649 Race
insurance status of, 83-87 defined, 490, 524-525
nurses, 117 ethnicity and immigration
with equal access to healthcare, 4, 33 advanced industrial (multinational)
Positron tomography, 129 capitalism, 468-469
Postmodernism, 495n commercial capitalism and the slave
Poverty rates, among minority and non- society, 466-467
minority individuals, 672 industrial capitalism, 466-469
OCR for page 758
758 INDEX
North American health and health populations with equal access to
care, 466-469 healthcare, 4, 33
pre-Columbian and North American relationship of health status to, 35-36
development, 466-467 relationship to broader racial attitudes
perceptions of violence, involuntary and discrimination, 101-102
commitment, and diagnosis of revised standards for the classification of
schizophrenia, 616-618 federal data on race and ethnicity,
Race-discordant dyads, 574 34
Racial and Ethnic Approaches to their documentation in the U.S., 487-489
Community Health (REACH), Racial and ethnic minority groups
386-387 defined, 32-33
Racial and ethnic disparities in healthcare share of the elderly population, 671
assessing potential sources of, 7-12 Racial attitudes
assumptions, 3-4, 30-35 discrimination in the United States, 6-7
background and history, 455-527 relations, 91-95
bias, stereotyping, prejudice, and clinical Racial categories for federal data
uncertainty on part of healthcare American Indian or Alaska Native, 34
providers contributing to, 12, 19, Asian, 34
178 Black or African American, 34
civil rights dimension of, 626-663 Native Hawaiian or other Pacific
culture of medicine and, 594-625 Islander, 34
data collection and monitoring, 21-22, White, 34
215-234, 460-464 Racial discrimination, 95-101
defining, 3-4 in criminal justice, 100-101
diagnosis and treatment of, 417-454 minority youth in the juvenile justice
ethical analysis of when and how they system, 100-101
matter, 722-738 defined, 95-96
evidence of, 5-6, 38-77 in employment, 100
existence and unacceptability of, 6, 19, 79 in housing, 96-100
federal-level and other initiatives to in mortgage lending, 96
address, 235, 384-391 Racial groups
focus group findings, 392-405 defined, 525
global problem, 441-442 hierarchies, 490-493
health disparities and Medicare and Racial models, as tools for analysis and
Medicaid administration, 681-693 understanding, 493-495
healthcare environment and its relation Racial profiling, the importance of data
to, 80-124 collection, 654-655
impact of cost containment efforts on, Racism, 491
699-721 aversive, 494
importance of, 36-38 competitive, 493
interventions to eliminate, 13-20 dominative, 494
many sources contributing to, 12, 19, 159 ideological, 523
minority patients more likely than white individual, 493
patients to refuse treatment, 8, 19, institutionalized, 494
179 internalized, 494, 524
occurring in the context of broader paternalistic, 493
historic and contemporary social personally mediated, 494, 524
and economic inequality, 6-7, 19, scientific, 501, 504, 525
123 societal, 493
patient-provider communication, 552- Racism in Medicine: An Agenda for Change,
593 441
OCR for page 759
759
INDEX
Radiographic services, 71-74, 129, 360-361 implementing multidisciplinary
RAND criteria, 45, 48, 57, 139, 143, 149 treatment and preventive care
RAND Health Insurance Survey, 702, 707, teams, 18, 21, 196
709-710 implementing patient education
Rationing of healthcare for American programs to increase patients’
Indians/Alaska Natives, 528-551 knowledge of how to best access
addressing health disparities, 548 care and participate in treatment
changes in the healthcare arena, 534-535 decisions, 19, 21, 198
compacting/contracting and including measures of racial and ethnic
improvement in quality of care, disparities in performance
543-545 measurement, 21-22, 233-234
effect of discrimination on quality of care increasing awareness of racial and ethnic
for tribal members, 545-548 differences in healthcare among
healthcare dollars, 536-537 healthcare providers, 6, 20, 124
history of health disparities among increasing awareness of racial and ethnic
American Indians/Alaska differences in healthcare among
Natives, 528-534 the general public and key
interviews, 539 stakeholders, 6, 20, 124
quality of healthcare received by tribal increasing the proportion of
communities, 539-543 underrepresented U.S. racial and
tribal/consumer perspectives, 537-539 ethnic minorities among health
Rawls, John, 726-728 professionals, 14, 20, 186
REACH 2010. See Racial and Ethnic integrating cross-cultural education into
Approaches to Community training of all current and future
Health health professionals, 20-21, 214
Recommendations monitoring progress toward elimination
applying same managed care protections of healthcare disparities, 21-22,
to publicly funded HMO 234
enrollees, 15, 20, 187 promoting the consistency and equity of
avoiding fragmentation of health plans care through the use of evidence-
along socioeconomic lines, 13, 20, based guidelines, 16, 20, 189-190
184 providing greater resources to the U.S.
collecting and reporting data on DHHS Office for Civil Rights to
healthcare access and utilization enforce civil rights laws, 15, 20,
by patient race, ethnicity, 188
socioeconomic status, and reporting racial and ethnic data by
primary language, 21-22, 233 federally defined categories, 21-
conducting further research to identify 22, 234
sources of radial and ethnic strengthening the stability of patient-
disparities and assessing provider relationships in publicly
promising intervention strategies, funded health plans, 14, 20, 185
23, 242-243 structuring payment systems to ensure
conducting research on ethical issues an adequate supply of services to
and other barriers to eliminating minority patients, 17, 20, 190-191
disparities, 23, 243 supporting the use of community health
enhancing patient-provider workers, 18, 21, 195
communication and trust by supporting the use of interpretation
providing financial incentives for services where community need
practices that reduce barriers, 17, exists, 17, 20, 193
20, 191 Reconstruction, in Black health, 509
OCR for page 760
760 INDEX
Redlining, 642-643 healthcare disparities among non-
Reducing Health Care Disparities National African American minority
Project, 388 groups, 240
Reductionism, defined, 525 identification of successful interventions
Reductionist thinking, 496 and programs in medical and
Referral patterns, access to specialty care, nursing education, 621
145-146 improving research on healthcare
Refusal of service, 174-175 disparities, 242-243
Registered nurse population, distribution influence of healthcare systems and
in geographic areas by racial/ settings on care for minority
ethnic background, 117 patients, 237-239
Rehabilitative services, 66, 360-363 monitoring healthcare disparities, 241
Relevance of causal stories, 729-736 patient-level influences on care, 237
brute luck and social structural political economy of cultural practices in
Egalitarian views of causality, medicine, 621
732-734 practice arrangements of minority
Libertarian views of the relevance of physicians, 621
causal explanations, 730-732 roles of non-physician health
relevance of individual causal professionals, 239-240
responsibility, 734-736 studies of DoD and VA systems, 238
Renaissance, 499 studies within healthcare plans, 237-238
Renal disease, 30, 435-437 types of hospital or clinic and racial and
Renal transplantation, 58-60, 362-365, 435- ethnic disparities in care, 238-239
437 Respect, lack of, 396-397
Reporting data on healthcare access and Retrenchment era in healthcare, 507-508
utilization, by patient race, Revascularization, 74, 427
ethnicity, socioeconomic status, Revised standards for the classification of
and primary language, 21-22, 233 federal data on race and ethnicity,
Reporting racial and ethnic data by 34
federally defined categories, 21- Revolutionary War, 470, 489
22, 234 Robert Wood Johnson Foundation, 421, 620
Reporting racial and ethnic disparities Roman Empire, 498
using existing data sets, 231-232
Republican period, 501
S
Research needed, 22-23, 235-243, 619-621
assessment of program successes
Sacher, David, 611, 620
redressing imbalances in care, 621
St. Francis Hospital, 485
changes in the ethnicity and race of
St. Vincent’s Hospital, 485
medical students, physicians,
SAMHSA. See Substance Abuse and Mental
nurses, and healthcare staff, 621
Health Services Administration
clinical decision-making and the roles of
San Diego County Sheriff’s Department,
stereotyping, uncertainty, and
655
bias, 236-237
Sandoval decision. See Alexander v. Sandoval
contribution of healthcare to health
Sanitary Commission Anthropometric
outcomes and the health gap
Study, 502
between minority and non-
Scala natura, 497
minority Americans, 241-242
SCHIP. See State Children’s Health
critical analysis of the culture of
Insurance Program
medicine, 620-621
Schizophrenia, African Americans and the
effectiveness of intervention strategies,
“over-diagnosis” of, 612-613
240-241
Schulman, Kevin, 635
OCR for page 761
761
INDEX
Scientific racism, 501, 504 Sources of medical care, those having no
defined, 525 usual, 109
Search keywords, 40 Sources of racial and ethnic disparities in
Segregation, contemporary de facto, 103-108 healthcare
Sen, Amartya, 728 assessing potential, 7-12
Service use, 71-74, 364-377 clinical encounter, 160-179
SES. See Socioeconomic status clinical uncertainty, 9
Settings in which racial and ethnic healthcare provider prejudice or bias, 10-
minorities receive healthcare, 108- 11
114 healthcare systems-level factors, 8-9
impact of community health centers on implicit nature of stereotypes, 10
healthcare in minority and medical decisions under time pressure
medically underserved areas, 112, with limited information, 11-12
114 patient- and system-level factors, 125-159
primary care visits made to primary care patient-level variables, 7-8
delivery sites by health insurance patient response, 12
payer and race/ethnicity, 113 role of bias, stereotyping, and
site of care in hospital settings, 110 uncertainty, 9-12
site of care in non-hospital facilities, 111 Southwest Native American Cardiology
site of usual source of care, by health Program, 389
insurance payer and race/ Sowell, Thomas, 496
ethnicity, 111 Spanish heritage, 480-481, 564
those having no usual source of medical “Spanish Language and Cultural
care, 109 Competence Curriculum,” 209
Shalala, Donna, 626, 657, 659 Special Programs Development Branch, 391
SHIRE. See Summit Health Institute for Specialized HIV/AIDS outreach and
Research and Education, Inc. substance abuse treatment, 390
Site of usual source of care, by insurance Spirit Catches You and You Fall Down, The,
and race/ethnicity, 111 605
Slave health deficit, defined, 525 SSA. See Social Security Administration
Slave health subsystem, 470-471 Staff-model HMOs, 115
defined, 525 Standardizing data collection, 215
Slave trade, 499-500 Standards, Training and Certification (STC)
Slavery, 458 Committee, 193
Smedley, Audrey, 490 Standards for the classification of federal
Smith, Charles Hamilton, 501 data on race and ethnicity, 34
Smith, David Barton, 638 American Indian or Alaska Native, 34
Smith, Sally, 531 Asian, 34
Snyder Act of 1921, 532-533 Black or African American, 34
Social Security Act, Title XXI, 680-681 Hispanic or Latino (“Spanish origin”), 34
Social Security Administration (SSA), 220, Native Hawaiian or other Pacific
223, 649, 668 Islander, 34
“Enumeration at Birth” program, 649 not Hispanic or Latino, 34
Master Beneficiary Record database, 224 White, 34
Social structural Egalitarian views of Standards of mental healthcare, for Latinos,
causality, brute luck and, 732-734 390
Societal racism, 493 Standards on Cultural and Linguistic
Sociocultural thinking, 496 Competence in 2000, 660
Socioeconomic status (SES), 68, 75, 166-167, State Children’s Health Insurance Program
286, 557-558, 595, 635 (SCHIP), 68, 220, 222, 629, 651,
Sources of health insurance by race and 659-660, 673-681
ethnicity, 84 applying for, 637, 648
OCR for page 762
762 INDEX
STC. See Standards, Training and Community Action Grant Program, 390
Certification Committee pocket guide and desk reference, 390
Stereotypes Special Programs Development Branch,
defined, 475, 525 391
effect of, 392-393 specialized HIV/AIDS outreach and
healthcare disparities, 172-174 substance abuse treatment, 390
implicit nature of, 10 standards of mental healthcare for
minority, defined, 524 Latinos, 390
Stinson, Nathan, 528 Summit Health Institute for Research and
Stories about misdiagnosis or improper Education, Inc. (SHIRE), 219-222
treatment, 401-402 Sunshine Amendment, 654
Stories of racial discrimination in Supplemental insurance coverage, among
healthcare practice, 392-398 minority and non-minority
effect of stereotyping, 392-393 Medicare beneficiaries, 672
improper diagnosis or treatment, 397- Supplemental Security Income, 675
398 Supply-side approaches, 703-705, 712-718
lack of respect, 396-397 capitation and DRGs, 713-715
language barriers, 393-395 cost containment and demand for
role of economics, 395 clinical services, 154-155
Strategic Research Agenda, 390 health plan payments to primary care
Strengthening physicians, 704
doctor-patient relationships, 13-14, 184- health plan payments to specialists, 704
186 low physician fees, 712-713
federal, state, and private healthcare, supply, technology, and expenditure
655-657 controls, 717-718
stability of patient-provider relationships utilization review and practice
in publicly funded health plans, guidelines, 716-717
14, 20, 185 Supreme Court. See U.S. Supreme Court
Stroke, 434-435 decisions
Structural thinking, 496 Surgeon General, 611, 614
Structuring payment systems to ensure an System strategies, 180-198
adequate supply of services to Systema Naturae, 499
minority patients, 17, 20, 190-191 Systematically disadvantaged
Student Physician, 599 neighborhoods, 100
Studies
assess appropriateness of services, 48-49
T
DoD and VA systems, 238
healthcare plans, 237-238
Task Force on Black and Minority Health,
role of financial and institutional
417
characteristics, 45-48
Teaching methods and opportunities, 207-
using administrative databases, 42-45
209
Subculture, defined, 525-526
Technical liaison panels, 278-283
Subjectivity
Terry, Robert W., 493
uncertainty, 128-130
Test of Functional Health Literacy
variability, 128
Assessment (TOFHLA), 570-571
Subordinate group, defined, 458, 526
Thai language, 89
Substance Abuse and Mental Health
Therapeutic cardiac procedures, 149
Services Administration
“Therapeutic social control,” 616
(SAMHSA), 385, 390-391
Third World IMGs, 116-120
American Indian and Alaskan Native
TIA. See Transient ischemic attack
Planning Grants, 391
OCR for page 763
763
INDEX
Title VI, 157, 159, 188, 192, 221, 628-631, Understanding and Eliminating Minority
637-641, 668, 679. See also Civil Health Disparities Initiative, 386
Rights Act Unfulfilled potential of Title VI, 157-159
access to medical treatment, 645-647 United Hospital Fund, 658
discrimination concerns unique to United Network for Organ Sharing, 436
immigrant populations, 647-649 United States-United Kingdom
enforcement history and the types of Collaborative Initiative on Racial
discrimination, 638-649 and Ethnic Health, 441
intentional discrimination, 639-640 United States v. Albank, 653
limited English proficiency, 640-642 United States v. Decatur Federal Savings and
managed care, 643-645 Loan, 653
redlining, 642-643 University of California at Davis, 596
Title VII, 631 University of New Mexico School of
TOFHLA. See Test of Functional Health Medicine, 597
Literacy Assessment University of Southern California Medical
Tools, Robert, 2 School, 634
Transient ischemic attack (TIA), 57, 434-435 Urban Institute, 96
Translating Research into Practice (TRIP), URM. See Underrepresented minority
386 students
Treatment U.S. Census Bureau, 81, 199, 461-463, 475,
cancer, 431-433 479, 481, 488
coronary artery disease, 425-431 U.S. Civil Rights Commission, 684
general medical and surgical care, 422- U.S. Constitution, 459
425 U.S. Department of Agriculture, 648
HIV/AIDS, 437-439 U.S. Department of Defense (DoD),
implications for change, 442-444 healthcare systems, 51, 148-150,
improper, 397-398 431, 433
overall pattern of evidence, 439-440 U.S. Department of Education, 571, 650
racial and ethnic disparities in care, 441- National Adult Literacy Survey (NALS),
442 571
renal disease and kidney U.S. Department of Health, Education, and
transplantation, 435-437 Welfare, 531. See also U.S.
review of the evidence and a Department of Health and
consideration of causes, 417-454 Human Services
stroke, 434-435 U.S. Department of Health and Human
Triage scoring, 153 Services (DHHS), 15, 123, 157, 159,
Tribal/consumer perspectives, 537-539 187, 192-193, 216-224, 226, 227n,
TRIP. See Translating Research into Practice 232, 234, 384-391, 487-488, 630,
Trujillo, Michael, 530 650, 657-660
Tuskeegee Syphilis Study, 131, 205 Agency for Healthcare Research and
Quality (AHRQ), 386
Centers for Disease Control and
U Prevention (CDC), 386-388
Centers for Medicare and Medicaid
UCLA Center for Health Policy Research, Services (CMS), 388
225
“Closing the Health Gap” campaign, 123
UCLA criteria, 48, 139 Data Council, 221
UCLA Medical Center, emergency Directory of Health and Human Services
department, 65
Data Resources, 223
Underrepresented minority (URM) Health Resources and Services
students, 121-122 Administration, 388-389
OCR for page 764
764 INDEX
V
Healthy People 2000, 226
HHS-wide initiatives, 384-385
Vaccination, 71-74, 374-375
Indian Health Service (IHS), 389
Van Ryn, Michelle, 635
Minority HIV/AIDS initiative, 384-385
Veterans Administration (VA) health
monitoring by, 158
system, 56-57, 71, 79, 85, 136-137,
National Institutes of Health (NIH), 389-
148-150, 430, 438, 530
390
Vietnamese Americans, 194, 479
Office for Civil Rights (OCR), 15, 157,
Vietnamese language, 90
187, 192, 218, 630-631, 638-649
Office of Minority Health (OMH), 181,
192, 218, 420
W
Office of the Secretary, 385-386
standards for culturally and War on Poverty, 531
linguistically appropriate services, Washington Civil Rights Initiative, 122
182-183
WASP. See White Anglo-Saxon Protestant
Substance Abuse and Mental Health Westat Corporation, 278
Services Administration White, Charles, 501
(SAMHSA), 390-391
White Anglo-Saxon Protestant (WASP), 483
U.S. Department of Housing and Urban White Christians, 498
Development (HUD), 99 White non-Hispanic ethnic groups, 482-483
Housing Discrimination Study, 99
Whites, 34
U.S. Department of Justice, 653-654 defined, 34, 474, 526
Bureau of Justice Statistics, 654 Wickline v. State of California, 684n
Civil Rights Division, 654
Williams, David, 621
Office for Civil Rights (OCR), 656 W.K. Kellogg Foundation, 421
U.S. Department of the Interior, 530-531 Women’s health services, 376-379
U.S. Department of Veterans Affairs, 391,
World Health Organization, 464
418. See also Veterans World War I, 504
Administration (VA) health World War II, 474, 486, 495, 506
system
Worldview, defined, 490, 526
Centers for Excellence, 391
U.S. Department of War, 530
U.S. Office of Juvenile Justice and X
Delinquency Prevention (OJJDP),
101 X-ray tomography, 129
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
Representative terms from entire chapter:
ethnic disparities
