Poor, Uninsured Perceive More Discrimination During Health Care Visits

Armen Hareyan's picture

For many Americans, poverty and lack of health insurance make it difficult to get necessary health and medical care. According to a new study, once they do visit the doctor, poor, uninsured people often report racial discrimination when communicating with health care professionals.

Irena Stepanikova, Ph.D., an assistant professor of sociology at the University of South Carolina, and a colleague evaluated data on 4,556 U.S. adults who participated in a telephone survey. Respondents noted whether they had experienced disrespect or unfair treatment during a health care visit because of their racial or ethnic background.

Especially for uninsured blacks, Hispanics and poor whites, "uninsurance and poverty are related to increased perceptions of racial and ethnic bias in health care," Stepanikova said.

Discrimination in health care is a significant problem, the authors say, because people who have experienced it are more likely to put off medical tests and procedures and less likely to receive preventive health care services, such as flu shots and cholesterol testing.

The study appears in the latest issue of the journal Health Services Research.

Overall, people without insurance had 2.39 times higher odds of perceiving racial and ethnic bias during health care visits, compared to people with private insurance. People living below the poverty line were also more likely to report feeling discriminated against.

In addition, African-Americans and Spanish-speaking Hispanics had almost eight times higher odds of perceiving racial bias compared to whites, whereas English-speaking Hispanics had more than four times higher odds of racial bias.


Whites living in poverty had nearly four times higher odds of reporting perceived racial and ethnic bias, compared to other whites.

In a follow-up question, patients noted that what had happened made them feel disrespected and unfairly judged.

"Among the most common reasons were, 'The doctor or staff talked down to me, took other patients before or instead of me, treated other patients better, didn't listen or pay enough attention to me, ignored me or didn't explain things well or at all,'" Stepanikova said. Insurance issues also played a role in patient perception of bias, she added

"Because this was a cross-sectional study, it is not possible to determine whether good physician-patient communication leads to lower levels of perceived racial and ethnic bias or whether improving physician-patient communication will reduce perceived bias," said Diana Burgess, Ph.D., an investigator with the Veterans Administration Medical Center, Minneapolis, who was not affiliated with this study.

Nevertheless, good communication between doctors and patients seemed to protect against racial discrimination. In the study, good physician-patient communication was associated with a 71 percent decrease in the odds of reporting racial and ethnic bias during health care visits.

According to Stepanikova, this finding suggests that breakdowns in communication between patients and physicians could lead to patients' perceptions of racial and ethnic discrimination in health care, regardless of the quality of care.

"Unfortunately, stereotyping and bias are more likely in situations in which providers are stressed and under time pressure -- attributes that may disproportionately afflict settings where minorities and the uninsured get care," Burgess said.

She said the good news is that "these processes are not inevitable and can be reduced if providers train themselves to be aware of stereotyping and try to focus on the individual attributes of the patient."