Dimensions: 5.5'' x 8.5'' 88 pages AEI Press  (Washington) Publication Date: January 2006 Paperback ISBN: 0-8447-7192-9 Price: $ 15.00 Add to Cart   Examination Copies

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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 are destined to be, at least in part, a function of residence.

Sally Satel, M.D., a psychiatrist, studies domestic drug policy, mental health policy (including the psychological impact of war and disasters), and political trends in medicine. Coauthor of One Nation Under Therapy and author of PC, M.D., she also works as a staff psychiatrist at the Oasis Drug Treatment Clinic. 

Jonathan Klick is the Jeffrey A. Stoops Professor of Law at the Florida State University in Tallahassee, Florida, and an adjunct scholar at the American Enterprise Institute in Washington, D.C. Klick received his law degree and his PhD in economics from George Mason University. He has published widely about health care economics and issues related to individuals' access to health care. He can be contacted at jklick@law.fsu.edu.

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On Feb. 22, AEI held an event on the The Health Disparities Myth. In addition to the authors, the following speakers participated in the event:

Dr. Peter B. Bach joined the Centers for Medicare and Medicaid Services (CMS) as a senior adviser to the administrator in February 2005. Dr. Bach’s work at CMS focuses on improving evidence about the effect of therapies and devices and revising payments to enhance care quality. He also is the agency lead on cancer policy. Dr. Bach is board certified in internal medicine, pulmonary medicine, and critical care medicine; in addition, he is an Associate Attending Physician at Memorial Sloan-Kettering Cancer Center in New York. He is a National Institutes of Health funded researcher with expertise in quality of care and epidemiologic research methods. His research on health disparities, variations in health-care quality, and lung cancer epidemiology has appeared several elite medical journals.

Amitabh Chandra is an assistant professor of public policy at Harvard University. He is a faculty research fellow at the Institute for the Study of Labor (IZA) in Bonn, Germany, and at the National Bureau of Economic Research in Cambridge, Massachusetts. His current research focuses on the effect of Title VII of the Civil Rights Act on labor markets, the role of medical malpractice litigation on the delivery of health care, and the economics of neonatal health and cardiovascular care. His research has been published in the The American Economic Review, the Journal of Political Economy, the Journal of Labor Economics, the Journal of Policy Analysis and Management, and Health Affairs. He is an editor of the journal Economics Letters. He has been a faculty member at Dartmouth and the Massachusetts Institute of Technology and has been a consultant to the National Academy of Science, the Robert Wood Johnson Foundation, and the RAND Corporation. He is the recipient of an Outstanding Teacher Award and is the first-prize recipient of the Upjohn Institute's International Dissertation Research Award.

Christopher Foreman is professor and director of the social policy program at the University of Maryland's School of Public Policy, where he teaches courses on political institutions and the politics of inequality. Professor Foreman came to the school in 2000 after more than a decade at the Brookings Institution, where he continues as a non-resident senior fellow in the governance studies program. In The Promise and Peril of Environmental Justice (Brookings, 1998), Foreman addresses the opportunities and constraints facing advocates and policymakers in the search for environmental equity. His interests include the politics of health, race, regulation, and government reform.

Linda S. Gottfredson is professor of education and affiliated faculty in the University Honors Program at the University of Delaware. She has published extensively on the impact of general intelligence on personal functioning in different life domains, including school, work, and health. Her articles and edited volumes, including “Intelligence and Social Policy” in Intelligence, examine how race and sex differences in abilities and interests create sociopolitical dilemmas for democratic societies and yield censored science. She has focused most recently on what makes some daily tasks more cognitively demanding than others, thereby putting less intellectually able individuals at greater risk of accidents; non-adherence to medical regimens; and failure to master the basic reading, writing, and reasoning tasks of modern life. She is on the editorial board of various journals, including Intelligence.