The Health Disparities Myth (Diagnosing the Treatment Gap)

Two fifty-year-old men arrive at an emergency room with acute chest pain. One is white and the other black. Will they receive the same quality of treatment and have the same chance of recovery? Many experts today insist that their race will profoundly affect how the medical-care system deals with them, and that the black patient will get much inferior care. Is this true? The Health Disparities Myth critically assesses recent research bearing on this question. Some scholars who study this question emphasize overt or subtle racial discrimination by physicians—the “biased-doctor model” of treatment disparities. But most of the studies that support this notion rely upon retrospective analyses of large health-system databases which are often missing critical variables that are linked to treatment decisions. Without adequate controls, it is simply not possible to attribute differences in care to physician “bias,” “discrimination,” or “prejudice,” as a much-cited 2002 Institute of Medicine report has done. Other scholars who have studied this question have focused on the influence of so-called “third factors” that are correlated with race, such as income, insurance status, and geographic location. In The Health Disparities Myth, Jonathan Klick and Sally Satel conclude that differences in treatment do indeed vary by race but not because of it. Data show that third factors, especially geography and socioeconomic factors, generate the strongest momentum in driving the treatment gap. White and black patients, on average, do not even visit the same population of physicians—making the idea of preferential treatment by individual doctors a far less compelling explanation for disparities in health than has been assumed. Doctors whom black patients tend to see may not be in a position to provide optimal care. Furthermore, because health care varies a great deal depending on where people live, and because blacks are overrepresented in regions of the United States served by poorer health care facilities, disparities ar