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How biases in healthcare can be deadly | Safia Hattab | TEDxHopeCollege

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The real reason American health care is so expensive

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About half of U.S. adults say they have difficulty affording health care costs.

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For many years, KFF polling has found that the high cost of health care is a burden on U.S. families, and that health care costs factor into decisions about insurance coverage and care seeking. These costs and the prospect of unexpected medical bills also rank as the top financial worries for adults and their families, and recent polling shows that lowering out-of-pocket health care costs is by and large the public's top health care priority. Health care affordability is also one of the top issues that voters want to hear presidential candidates talk about during the 2024 election. This data note summarizes recent KFF polling on the public's experiences with health care costs. Main takeaways include:

About half of U.S. adults say it is difficult to afford health care costs, and one in four say they or a family member in their household had problems paying for health care in the past 12 months. Younger adults, those with lower incomes, adults in fair or poor health, and the uninsured are particularly likely to report problems affording health care in the past year.

The cost of health care can lead some to put off needed care. One in four adults say that in the past 12 months they have skipped or postponed getting health care they needed because of the cost. Notably six in ten uninsured adults (61%) say they went without needed care because of the cost.

The cost of prescription drugs prevents some people from filling prescriptions. About one in five adults (21%) say they have not filled a prescription because of the cost while a similar share say they have instead opted for over-the-counter alternatives. About one in ten adults say they have cut pills in half or skipped doses of medicine in the last year because of the cost.

Those who are covered by health insurance are not immune to the burden of health care costs. About half (48%) of insured adults worry about affording their monthly health insurance premium and large shares of adults with employer-sponsored insurance (ESI) and those with Marketplace coverage rate their insurance as "fair" or "poor" when it comes to their monthly premium and to out-of-pocket costs to see a doctor.

Health care debt is a burden for a large share of Americans. About four in ten adults (41%) report having debt due to medical or dental bills including debts owed to credit cards, collections agencies, family and friends, banks, and other lenders to pay for their health care costs, with disproportionate shares of Black and Hispanic adults, women, parents, those with low incomes, and uninsured adults saying they have health care debt.

Notable shares of adults still say they are worried about affording medical costs such as unexpected bills, the cost of health care services (including out-of-pocket costs not covered by insurance, such as co-pays and deductibles), prescription drug costs, and long-term care services for themselves or a family member. About three in four adults say they are either "very" or "somewhat worried" about being able to afford unexpected medical bills (74%) or the cost of health care services (73%) for themselves and their families. Additionally, about half of adults would be unable to pay an unexpected medical bill of $500 in full without going into debt.

Difficulty Affording Medical Costs

Many U.S. adults have trouble affording health care costs. While lower income and uninsured adults are the most likely to report this, those with health insurance and those with higher incomes are not immune to the high cost of medical care. About half of U.S. adults say that it is very or somewhat difficult for them to afford their health care costs (47%). Among those under age 65, uninsured adults are much more likely to say affording health care costs is difficult (85%) compared to those with health insurance coverage (47%). Additionally, at least six in ten Black adults (60%) and Hispanic adults (65%) report difficulty affording health care costs compared to about four in ten White adults (39%). Adults in households with annual incomes under $40,000 are more than three times as likely as adults in households with incomes over $90,000 to say it is difficult to afford their health care costs (69% v. 21%). (Source: KFF Health Care Debt Survey: Feb.-Mar. 2022)

When asked specifically about problems paying for health care in the past year, one in four adults say they or a family member in their household had problems paying for care, including three in ten adults under age 50 and those with lower household incomes (under $40,000). Affording health care is particularly a problem for those who may need it the most as one-third of adults who describe their physical health as "fair" or "poor" say they or a family member had problems paying for health care in the past 12 months. Among uninsured adults, half (49%) say they or a family member in their household had problems paying for health care, including 51% of uninsured adults who say they are in fair or poor health.

The cost of care can also lead some adults to skip or delay seeking services. One-quarter of adults say that in the past 12 months, they have skipped or postponed getting health care they needed because of the cost. The cost of care can also have disproportionate impacts among different groups of people; for instance, women are more likely than men to say they have skipped or postponed getting health care they needed because of the cost (28% vs. 21%). Adults ages 65 and older, most of whom are eligible for health care coverage through Medicare, are much less likely than younger age groups to say they have not gotten health care they needed because of cost.

One in four immigrant adults (22%) say they have skipped or postponed care in the past year, rising to about a third (36%) among those who are uninsured. Seven in ten (69%) of immigrant adults who skipped or postponed care (15% of all immigrant adults) said they did so due to cost or lack of health coverage. (Source: The 2023 KFF/LA Times Survey of Immigrants: Apr.-June 2023)

Six in ten uninsured adults (61%) say they have skipped or postponed getting health care they needed due to cost. Health insurance, however, does not offer ironclad protection as one in five adults with insurance (21%) still report not getting health care they needed due to cost.

KFF health polling from March 2022 also looked at the specific types of care adults are most likely to report putting off and found that dental services are the most common type of medical care that people report delaying or skipping, with 35% of adults saying they have put it off in the past year due to cost. This is followed by vision services (25%), visits to a doctor's offices (24%), mental health care (18%), hospital services (14%), and hearing services, including hearing aids (10%). (Source: KFF Health Tracking Poll: March 2022)

A 2022 KFF report found that people who already have debt due to medical or dental care are disproportionately likely to put off or skip medical care. Half (51%) of adults currently experiencing debt due to medical or dental bills say in the past year, cost has been a probititor to getting the medical test or treatment that was recommended by a doctor. (Source: KFF Health Care Debt Survey: Feb.-Mar. 2022)

Prescription Drug Costs

For many U.S. adults, prescription drugs are a component of their routine care. More than one in four (28%) adults say it is either "somewhat" or "very difficult" for them to afford to pay for prescription drugs. Affording prescription drugs is particularly difficult for adults who take four or more prescription medications (37%) and those in households with annual incomes under $40,000 (40%). Black and Hispanic adults are also more likely than White adults to say it is difficult for them to afford to pay for prescription drugs. (Source: KFF Health Tracking Poll: July 2023)

The high cost of prescription drugs also leads some people to cut back on their medications in various ways. About one in five adults (21%) say in the past 12 months they have not filled a prescription because of the cost. A similar share (21%) say they have taken an over-the-counter drug instead of getting a prescription filled - rising to about one third of Hispanic adults (32%) and more than one in four adults (27%) with annual household incomes under $40,000. About one in ten adults say that in the past 12 months they have cut pills in half or skipped doses of medicine due to cost. (Source: KFF Health Tracking Poll: July 2023)

Health Insurance Cost Ratings

Overall, most insured adults rate their health insurance as "excellent" or "good" when it comes to the amount they have to pay out-of-pocket for their prescriptions (61%), the amount they have to pay out-of-pocket to see a doctor (53%), and the amount they pay monthly for insurance (54%). However, at least three in ten rate their insurance as "fair" or "poor" on each of these metrics, and affordability ratings vary depending on the type of coverage people have.

Adults who have private insurance through employer-sponsored insurance or Marketplace coverage are more likely than those with Medicare or Medicaid to rate their insurance negatively when it comes to their monthly premium, the amount they have to pay out of pocket to see a doctor, and their prescription co-pays. About one in four adults with Medicare give negative ratings to the amount they have to pay each month for insurance and to their out-of-pocket prescription costs, while about one in five give their insurance a negative rating when it comes to their out-of-pocket costs to see a doctor.

Medicaid enrollees are less likely than those with other coverage types to give their insurance negative ratings on these affordability measures (Medicaid does not charge monthly premiums in most states, and copays for covered services, where applied, are required to be nominal.) (Source: KFF Survey of Consumer Experiences with Health Insurance)

Health Care Debt

In June 2022, KFF released an analysis of the KFF Health Care Debt Survey, a companion report to the investigative journalism project on health care debt conducted by KFF Health News and NPR, Diagnosis Debt. This project found that health care debt is a wide-reaching problem in the United States and that 41% of U.S. adults currently have some type of debt due to medical or dental bills from their own or someone else's care, including about a quarter of adults (24%) who say they have medical or dental bills that are past due or that they are unable to pay, and one in five (21%) who have bills they are paying off over time directly to a provider. One in six (17%) report debt owed to a bank, collection agency, or other lender from loans taken out to pay for medical or dental bills, while similar shares say they have health care debt from bills they put on a credit card and are paying off over time (17%). One in ten report debt owed to a family member or friend from money they borrowed to pay off medical or dental bills.

While four in ten U.S. adults have some type of health care debt, disproportionate shares of lower income adults, the uninsured, Black and Hispanic adults, women, and parents report current debt due to medical or dental bills.

Vulnerabilities and Worries About Health Care and Long-Term Care Costs

A February 2024 KFF Health Tracking Poll shows unexpected medical bills and the cost of health care services are at the top of the list of people's financial worries, with about three-quarters of the public - and similar shares of insured adults younger than 65 - saying they are at least somewhat worried about affording unexpected medical bills (74%) or the cost of health care services (73%) for themselves and their families. Just over half (55%) of the public say they are "very" or "somewhat worried" about being able to afford their prescription drug costs, while about half (48%) of insured adults say they are worried about affording their monthly health insurance premium.

Worries about health care costs pervade among a majority of adults regardless of their financial situation. Among adults who report difficulty affording their monthly bills, more than eight in ten say they are worried about the cost of health care services (86%) or unexpected medical bills (83%). Among those who report being just able to afford their bills, about eight in ten say they are worried about being able to afford unexpected medical bills (84%) or health care services (83%). And even among adults who say they can afford their bills with money left over, six in ten nonetheless say they are "very" or "somewhat worried" about being able to afford unexpected medical bills (62%) or the cost of health care services (60%) for themselves and their family. (Source: KFF Health Tracking Poll: February 2024)

Many U.S. adults may be one unexpected medical bill from falling into debt. About half of U.S. adults say they would not be able to pay an unexpected medical bill that came to $500 out of pocket. This includes one in five (19%) who would not be able to pay it at all, 5% who would borrow the money from a bank, payday lender, friends or family to cover the cost, and one in five (21%) who would incur credit card debt in order to pay the bill. Women, those with lower household incomes, Black and Hispanic adults are more likely than their counterparts to say they would be unable to afford this type of bill. (Source: KFF Health Care Debt Survey: Feb.-Mar. 2022)

Among older adults, the costs of long-term care and support services are also a concern. Almost six in ten (57%) adults 65 and older say they are at least "somewhat anxious" about affording the cost of a nursing home or assisted living facility if they needed it, and half say they feel anxious about being able to afford support services such as paid nurses or aides. These concerns also loom large among those between the ages of 50 and 64, with more than seven in ten saying they feel anxious about affording residential care (73%) and care from paid nurses or aides (72%) if they were to need these services. See The Affordability of Long-Term Care and Support Services: Findings from a KFF Survey for a deeper dive into concerns about the affordability of nursing homes and support services.

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Americans' Challenges with Health Care Costs | KFF

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This data note reviews our recent polling data that finds that Americans struggle to afford many aspects of health care, including disproportionate shares of uninsured adults, Black and Hispanic adults and those with lower incomes.

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Health Care in America: Insurance Gaps and Medical Deserts

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Forty-three percent of working-age adults were inadequately insured in 2022.

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With this year's survey, the Commonwealth Fund introduces a new baseline. Historically, the Commonwealth Fund Biennial Health Insurance Survey was conducted exclusively using phone administration via stratified random-digit dial (RDD) phone sample. This year, however, we shifted to a hybrid sample design that utilized stratified address-based sample (ABS), combined with SSRS Opinion Panel, and prepaid cell phone sample. Other changes include expanding the survey to include all adults age 19 and older and making refinements to how we calculate poverty status and determine underinsurance for borderline cases. Collectively, these changes affect year-to-year differences in our trend questions. For that reason, this year's brief does not report on trends.

The Commonwealth Fund Biennial Health Insurance Survey, 2022, was conducted by SSRS from March 28 through July 4, 2022. The survey consisted of telephone and online interviews in English and Spanish and was conducted among a random, nationally representative sample of 8,022 adults age 19 and older living in the continental United States. A combination of address-based, SSRS Opinion Panel, and prepaid cell phone samples were used to reach people. In all, 3,716 interviews were conducted online or on the phone via ABS, 3,656 were conducted online via the SSRS Opinion Panel, and 650 were conducted on prepaid cell phones.

The sample was designed to generalize to the U.S. adult population and to allow separate analyses of responses from low-income households. Statistical results were weighted in stages to compensate for sample designs and patterns of nonresponse that might bias results. The first stage involved applying a base weight to account for different selection probabilities and response rates across sample strata. In the second stage, sample demographics were poststratified to match population parameters. The data are weighted to the U.S. adult population by sex, age, education, geographic region, family size, race/ethnicity, population density, civic engagement, and frequency of internet use, using the 2019 and 2021 U.S. Census Bureau's Current Population Survey (CPS), the 2015-2019 American Community Survey (ACS) 5-Year Estimates, and Pew Research Center's 2021 National Public Opinion Reference Survey (NPORS).

The resulting weighted sample is representative of the approximately 254 million U.S. adults age 19 and older. The survey has an overall maximum margin of sampling error of +/- 1.5 percentage points at the 95 percent confidence level. As estimates get further from 50 percent, the margin of sampling error decreases. The ABS portion of the survey achieved an 11.4 percent response rate, the SSRS Opinion Panel portion achieved a 2 percent response rate, and the prepaid cell portion achieved a 2.9 percent response rate.

This brief focuses on adults under age 65. The resulting weighted sample is representative of approximately 196.7 million U.S. adults ages 19 to 64. The survey has a maximum margin of sampling error of +/- 1.7 percentage points at the 95 percent confidence level for this age group.

Refinements to Poverty Status

A respondent's household size and income are used to determine poverty status.

Previously, household size was determined by combining information about marital status and the presence of dependents under age 25 in the household, which resulted in a maximum possible household size of four persons. This year, we used a new survey question where respondents provided an open-ended numeric response. This allowed us to use the full U.S. Federal Poverty Guidelines up to 14 household members.

To create a fully populated income variable, we used hot deck imputation to populate income ranges for respondents that did not answer income questions. We then generated random exact incomes for each respondent. Respondent incomes within each income range were assumed to be uniformly distributed and were assigned using a standard increment between each income based on the size of the income range and the number of respondents with incomes in the range.

The more precise household size and random exact incomes were used to determine poverty status for all respondents according to the 2021 U.S. Federal Poverty Guidelines.

Refinements to Underinsurance Components

Underinsured adults are individuals who are insured all year but report at least one of three indicators of financial exposure relative to income: 1) out-of-pocket costs, excluding premiums, are equal to 10 percent or more of household income; or 2) out-pocket-costs, excluding premiums, are equal to 5 percent or more of household income (if living under 200 percent of the federal poverty level); or 3) their deductible is 5 percent or more of household income.

For each of the three underinsurance component measures, there are borderline cases for which the income ranges provided are too imprecise to categorize the respondent into "less than" or "more than" the stated underinsurance component. Previously, the Fund redistributed borderline cases for each component by conducting a 50/50 split into the "less than" and "more than" categories. This year we leveraged the imputed income ranges and random exact incomes generated to determine poverty status to categorize borderline cases.

Additionally, for those respondents who provided deductibles, we duplicated the methodology used to determine random exact incomes to compute random exact deductibles. These exact deductibles were compared to exact incomes to categorize borderline cases for the component of underinsurance that relates deductible to income.

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The State of U.S. Health Insurance in 2022

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This brief presents findings from the Commonwealth Fund Biennial Health Insurance Survey to describe the state of Americans' health insurance coverage in 2022.

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Jennifer Tolbert, Patrick Drake, and Anthony Damico Published: Dec 19, 2022

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Key Facts about the Uninsured Population | KFF

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This issue brief describes trends in health coverage prior to the pandemic, examines the characteristics of the uninsured population in 2019, and summarizes the access and financial implications of not having coverage.

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More than 1 in 5 U.S. adults without access to a vehicle or public transportation missed or skipped a medical appointment in the previous year, according to a new study that sheds light on a key social driver of health equity.

Why it matters: While telehealth may have reduced transportation barriers for mental health, primary care and some other services, it's not accessible to all and can't substitute for in-person care for some medical needs, the Urban Institute researchers wrote.

The findings point to gaps that could be filled by Medicaid coverage of nonemergency medical transportation, which varies by state, or expanded access to telehealth where public transit options are limited, they said.

What they found: 21% of adults without access to a vehicle or public transit went without needed medical care last year.

About 5% of nonelderly adults didn't get needed care in the past year because of difficulty finding transportation, an experience more common among individuals from low-income families, people with disabilities and those on public health programs.

Though 91% of adults said they had access to a vehicle, the figure was substantially lower Black adults (81%), those with low family incomes (78%) or a disability (83%) and for individuals with public health insurance (79%) or no coverage (83%).

The study draws on data from the June 2022 round of the Urban Institute's Health Reform Monitoring Survey of adults ages 18 to 64.

Go deeper: Research suggests that 10% of a person's health can be attributed to the physical environment, including transportation.

The pandemic experience and heightened awareness of racial inequalities are prompting some cities to rethink the mobility revolution to ensure there's more equitable access, as Axios' Joann Muller has written.
Editor's note: This report was corrected to reflect that research suggests 10% of a person's health can be attributed to the physical environment, including transportation, not 40%.

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Over 1 in 5 skip health care due to transportation barriers

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More than 1 in 5 U.S adults without access to a vehicle or public transportation missed or skipped a medical appointment last year.

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A person should always receive good healthcare, regardless of personal characteristics, identities, or traits such as race or gender. Unfortunately, certain implicit biases exist in healthcare. These can have detrimental effects on the quality of healthcare a person receives.

Healthcare professionals should provide impartial care to every patient. However, some people may receive varying levels of care as a result of the biases of healthcare staff and medical researchers.

Bias and discrimination occur at both the interpersonal and the institutional level of healthcare. Bias can lead to people receiving poor treatment, receiving inaccurate diagnoses, or experiencing delays in diagnosis. It can also lead to stress, which can worsen health conditions.

This article will go into detail about healthcare biases, examples of the groups of people affected, and strategies for overcoming biases.

The word "bias" refers to a negative or positive idea a person has about someone or something. A person's bias can affect how they interact with people of certain groups.

An implicit bias is a bias that a person is unaware of. A person who has an implicit bias may believe they treat everyone equally. However, the person's implicit bias may cause unconscious negative associations toward certain groups of people.

The 2019 National Healthcare and Disparities Report found that white patients were more likely to receive better quality care than:

Black patients

Native American patients

Alaska Native patients

Hispanic patients

Native Hawaiian/Pacific Islander patients

Racial bias in healthcare Black, Indigenous, and People of Color (BIPOC) having a harder time accessing healthcare. This can mean a Person of Color has delays in treatment, leading to worse outcomes.

A review from 2016 noted that some physicians were significantly more likely to recommend white patients for bypass surgery than Black patients. This difference was due to the physicians' belief that their Black patients were not as well educated and so would not take part in the necessary physical activity after surgery.

More on racial disparities in healthcare:

A review from 2018 found that some medical professionals were more likely to dismiss chronic pain in women than in men.

In their review of 77 articles, the researchers found that some medical professionals were more likely to view men as strong and stoic when dealing with pain. This belief can lead to men not seeking help when they need to in order to avoid looking "weak."

On the other hand, the review noted that medical professionals were more likely to view women with chronic pain as emotional, hysterical, or sensitive. They were also more likely to consider women time-consuming or frustrating.

Sex and gender biases can cause people to feel ashamed or silenced when it comes to their health conditions. This can mean that a person will avoid seeing their doctor, leading to delays in treatment.

These biases also apply to transgender people. Transgender people may be to receive healthcare because they have concerns about being unfairly or inappropriately treated.
Learn more about cissexism here.
Research from 2015 found that a majority of heterosexual healthcare professionals implicitly preferred straight people over lesbian or gay people. Additionally, a study from 2019 found that more than 80% of medical students had an implicit bias against lesbian and gay people.

Perceived discrimination from healthcare professionals can contribute to LGBTQIA+ people avoiding treatment. Researchers from the same 2019 study noted that avoidance of healthcare is part of the reason LGBTQIA+ people have higher rates of:
Learn more about heterosexism here.
A study from 2017 found that healthcare professionals were more likely to assume that older adult patients will be:

unwilling to receive treatment

offensive

helpless

demanding

This study also noted that some healthcare professionals may be less likely to recommend older adults for invasive or aggressive procedures. They may feel that this is a more "compassionate" choice. However, missing out on these treatments can result in lower quality of life for older adults and possibly cause death.

The researchers note that this was a relatively small study and further research is required to determine the extent of ageism in healthcare.

Ableism is the belief that people with disabilities are not as capable or valuable as people without disabilities. Ableism in healthcare can mean that a person with a disability receives lower quality care than they should.

A study from 2020 found that 83.6% of healthcare professionals included in the study implicitly preferred people without disabilities. These professionals may view people with disabilities as having lower quality of life or being unwell as a result of their disability.

Bias can also exist in the facilities where people receive treatment. People with disabilities may not be able to access certain areas of a healthcare center. A person who uses a wheelchair may find that some equipment cannot be adjusted to examine them.

People with disabilities can experience the following secondary conditions to inaccessible healthcare:

Various healthcare biases exist surrounding people with obesity. A suggested that healthcare professionals can view people with obesity as:

lazy

weak-willed

lacking self-control

unwilling to follow recommendations

unlikely to stick to treatments

Healthcare professionals were also prone to attributing a person's symptoms to their obesity. A healthcare professional may therefore recommend that a person lose weight rather than providing treatment for their condition.

If a person with obesity receives poor treatment from their healthcare provider, they may not seek help when they need it. Research from 2016 found that of women with obesity saw weight as a barrier to their healthcare.

A person's socioeconomic status is based on social and economic factors such as income and employment. Research from 2017 suggested that some physicians may be less likely to think that people from low socioeconomic backgrounds are:

intelligent

independent

responsible

rational

likely to comply with medical advice or return for follow-up treatments

Researchers in this study also suggested that some physicians were more likely to delay testing and avoid referral for specialty treatments for people with low socioeconomic statuses.

The researchers then noted that a majority of people with low socioeconomic status found that this status was a barrier to their healthcare. Those people experienced worsening health conditions as a result of that barrier.

A person's level of education can affect their level of health. Research from 2018 noted that people with lower levels of education reported:

worse general health

more chronic conditions

more limitations and disabilities

There is limited research regarding education bias in healthcare. The above article notes that education plays only a modest role in explaining health inequities between people with higher and lower levels of education.

Where a person lives can affect how their healthcare professionals treat them.

Rural populations in the United States :

be older

lack health insurance

be less likely to have higher education

In contrast, people who live in urban areas are more likely to:

experience poverty

have been born outside the United States

not own their homes

This can mean that people who live in urban or rural areas are subject to a variety of the previously mentioned biases from their healthcare professionals.

Geographic location also plays an important role in many social determinants of health.
Learn what social determinants of health are here.
It is important that all people have access to the same levels of healthcare. Healthcare professionals need to be aware of any implicit biases they may have and work to remove them.

Techniques that can help reduce bias in healthcare include:

more education on health disparities

positive and frequent intergroup contact with different historically marginalized groups

providing patients with a list of questions to ask regarding their condition, which can lead to extended and more in-depth conversations with their healthcare professionals

an awareness of the additional needs of patients with disabilities, such as braille on signs

Learn more about health equity and how to promote it here.
Many biases can exist in healthcare. People from historically marginalized groups may be subject to unfair prejudices that stem from healthcare professionals' implicit biases.

Bias in healthcare can lead to lower quality healthcare among people from certain groups. Reductions in healthcare can cause these groups to receive incorrect diagnoses, experience delays in treatment, or avoid treatment altogether.

Healthcare professionals should be aware of any biases they have and work on overcoming them. People can work on their healthcare bias through various methods, such as working with people from historically marginalized groups and seeking education on health disparities.

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Biases in healthcare: Types, examples, overcoming bias

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Some biases exist in healthcare that can affect the treatment a person receives. Bias may involve a person's race, sexuality, age, and more.

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Work to elect people who have interests of regular people - to expand Medicaid and get a single-payer system or Medicare for all.

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Recent studies have shown that despite the improvements in the overall health of the country, racial and ethnic minorities experience a lower quality of health care-they are less likely to receive routine medical care and face higher rates of morbidity and mortality than nonminorities.

The American Medical Association (AMA) encourages physicians to examine their own practices to ensure equality in medical care.

The AMA's mission is to achieve health equity by mitigating disparity factors in the patient population.

Health Disparities Toolkit. This kit focuses on the theme of "Working Together to End Racial and Ethnic Disparities: One Physician at a Time." Access DVD interviews with physicians, nurses and patients, and a CD of information on topics such as cultural competence and literacy. Use the facilitation guide to work with other health care providers and physicians.

Explore the AMA's Code of Medical Ethics to answer questions on ethical and professional issues for physicians.

Access the white paper on " Collecting and Using Race, Ethnicity and Language Data in Ambulatory Settings (PDF)" to find recommendations from the Commission to End Health Care Disparities on how to use demographic data to achieve practical goals.

The Institute of Medicine (IOM) performed an assessment on the differences in the kinds and quality of health care received by U.S. racial and ethnic minorities and nonminorities.

The IOM report found that:

Disparities in health care exist and are associated with worse health outcomes.

Health care disparities occur in the context of broader inequality.

There are many sources across health systems, providers, patients and managers that contribute to disparities.

Bias, stereotyping, prejudice and clinical uncertainty contribute to disparities.

A small number of studies suggest that racial and ethnic minority patients are more likely to refuse treatment.

Read a summary the IOM findings (PDF) and recommendations, or access the complete IOM report.

The IOM concluded that a comprehensive, multilevel strategy is needed to eliminate these disparities.

Access the National Healthcare Quality & Disparities Report for additional information. This annual report is produced by the Agency for Healthcare Research and Quality.

The AMA works to increase the number of minority physicians to reflect the diversity of the U.S. population through its policies and advocacy work.

The AMA's House of Delegates prioritizes the elimination of racial and ethnic health disparities as a top importance.

The AMA is partnering with the AMA Foundation to help physicians become aware and manage low health literacy among patients through its public health grants.

AMA has enacted policies that support the research findings from the IOM and support the goals of reducing disparities in health care.

These policies aim to:

Increase awareness of racial and ethnic disparities in health care among the general public.

Strengthen patient-provider relationships in publicly funded health plans.

Apply the same managed care protections to publicly funded HMO participants that apply to private HMO participants.

Explore more in AMA's PolicyFinder.

In 2000, the U.S. Department of Health and Human Services launched Healthy People 2010, which had two broad goals: to improve the overall health status of Americans and to eliminate racial and ethnic health care disparities.

Health and Human Services officials deemed the AMA was ideally positioned to bring national leadership to initiatives in disease prevention and health promotion while working to eliminate health care inequalities.

The AMA agreed to raise awareness of health imbalances and the importance of understanding culturally competent health care and health literacy by working with state medical societies, medical schools, medical students and policymakers.

In 2004, the Commission to End Health Care Disparities was established by the AMA and the National Medical Association to address gaps in health care. The National Hispanic Medical Association joined shortly after.

In June of 2016, the commission was retired, but the resources and materials produced by the commission are available on this page for physicians.

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Read about the AMA's goal to ensure that all communities across the United States receive equal access to quality health care in order to reduce health care disparity nationwide. Here you'll find our health disparities definition, causes of disparities and more.

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Until disparities are addressed, health care will remain a social injustice.

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Until disparities are addressed, health care will remain a social injustice.

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Centers for Disease Control and Prevention

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What Are Social Determinants of Health?

Social determinants of health (SDOH) are the nonmedical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies, racism, climate change, and political systems. Centers for Disease Control and Prevention (CDC) has adopted this SDOH definition from the World Health Organization.

What is CDC Doing to Address SDOH?

SDOH are one of three priority areas for Healthy People 2030, along with health equity and health literacy. Healthy People 2030 sets data-driven national objectives in five key areas of SDOH: healthcare access and quality, education access and quality, social and community context, economic stability, and neighborhood and built environment. Some examples of SDOH included in Healthy People 2030 are safe housing, transportation, and neighborhoods; polluted air and water; and access to nutritious foods and physical health opportunities.

What Public Health Actions Can Affect SDOH?

Public health organizations can convene, integrate, influence, and contribute to big changes.

How is CDC Addressing SDOH?

CDC has taken multiple steps to ensure efforts to address SDOH are built into the agency's work.

CDC SDOH Resources Additional SDOH Resources SDOH Publications

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Find information about social determinants of health (SDOH) and what CDC is doing to address SDOH.

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Community forums and organizations, including using Better Business Bureau or Area Agencies on Aging, educate people about health insurance and break it down to make it make more sense.

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How to Improve Access to Health Care: Issues & Solutions | USC EMHA

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Why do so many people forgo much-needed medical care? Explore the barriers to health care in the U.S. and how to improve access to health care for all.

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Traveling Towards Disease: Transportation Barriers to HealthCare Access

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Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use (Syed, Gerber, and Sharp, 2013, p. 1).

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Each year, 3.6 million people in the United States do not obtain medical care due to transportation issues (AHA, n.d.).

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Social Determinants of Health Series: Transportation and the Role of Hospitals | AHA

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“Transportation and the Role of Hospitals” is part of a series of guides and resources released by the AHA on how hospitals and health systems can address the social determinants of health (SDOH).

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The United States has the highest per capita health expenditures.

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Where does the money go?

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Who pays the bill?