Assessing Potential Sources of Racial and Ethnic Disparities in Care: The Clinical Encounter

Previous chapters have assessed the extent of racial and ethnic disparities in healthcare, and have identified potential sources of these disparities. Disparities are found to arise from an historic and social context in which racial and ethnic minorities received inferior healthcare, reflecting broader socioeconomic disadvantage among minorities and societal discrimination. When seen by a healthcare provider, minorities typically have been treated in segregated healthcare systems that today remain largely segmented by socioeconomic class. When differences in treatment attributable to insurance, access to care, health status, and other factors are eliminated, however, racial and ethnic healthcare disparities still remain. As discussed in Chapter 3, factors related to patients’ needs and preferences, as well as the characteristics of health systems and the legal and regulatory contexts in which care is delivered, may explain some of the racial and ethnic differences in care that remain once access-related factors are controlled. In this chapter, aspects of the clinical encounter that may contribute to disparities—including patients’ and providers’ attitudes, expectations, and behavior—are assessed. When these encounters systematically produce racial and ethnic disparities, they may constitute discrimination. As noted in Chapter 1, the study committee defines discrimination as differences in care that emerge from biases and prejudice, stereotyping, and uncertainty in communication and clinical decisionmaking. It should be emphasized that this definition is not intended in a legal sense. Different sources of federal, state and international law de-