, Volume 467, Issue 10, pp 2598-2605
Date: 05 Aug 2009

Getting to Equal: Strategies to Understand and Eliminate General and Orthopaedic Healthcare Disparities

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Abstract

The 2001 Institute of Medicine report entitled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care pointed out extensive healthcare disparities in the United States even when controlling for disease severity, socioeconomic status, education, and access. The literature identifies several groups of Americans who receive disparate healthcare: ethnic minorities, women, children, the elderly, the handicapped, the poor, prisoners, lesbians, gays, and the transgender population. Disparate healthcare represents an enormous current challenge with substantial moral, ethical, political, public health, public policy, and economic implications, all of which are likely to worsen over the next several decades without immediate and comprehensive action. A review of recent literature reveals over 100 general and specific suggestions and solutions to eliminate healthcare disparities. While healthcare disparities have roots in multiple sources, racial stereotypes and biases remain a major contributing factor and are prototypical of biases based on age, physical handicap, socioeconomic status, religion, sexual orientation or other differences. Given that such disparities have a strong basis in racial biases, and that the principles of racism are similar to those of other “isms”, we summarize the current state of healthcare disparities, the goals of their eradication, and the various potential solutions from a conceptual model of racism affecting patients (internalized racism), caregivers (personally mediated racism), and society (institutionalized racism).
One of the authors (AAM) has received funding from The McKesson Foundation, Blue Cross Blue Shield of Massachusetts, The J. Robert Gladden Orthopaedic Society, The Josiah Macy, Jr., Foundation, and The Arthur and Barbara Higgins Charitable Foundation.
This work was performed at Twin Cities Spine Center, Minneapolis, MN.