1) How do individual physicians contribute to health care disparities? Thinking about an area of health care of particular interest to you, what research do you think could be done to either understand the effect of individual physicians on health disparities, or to decrease this effect?
Individual physicians contribute to health care disparities in a variety of ways. One way is in the types of insurance that they accept. If, for example, a specialist does not take certain insurance because of the compensation rate it may lead to a health care disparity. In the example of lung transplantation, patients need to have certain insurance which will pay for the transplant care. This can introduce health care disparities because if they do not have access to the insurance that is willing to pay for the transplant then they will not be able to have access to transplantation. One way to combat this issue in health care disparities is to have an external funding mechanism that is provided to support people who do not have the insurance requirements for transplantation. Another potential way that an individual physician can contribute to health care disparities is through implicit bias. All people have some component of implicit bias. When a patient comes to see a transplant physician they evaluate the patient’s medical literacy and capability to deal with the complexities of having a transplant. If physician has implicit bias about a certain racial/ethnic group then they may unintentionally believe that the patient is not as good of a candidate because of the implicit bias. One way to combat this is to have educational sessions for physicians about implicit bias training. This could be done in a research endeavor where you assess the transplant listing before and after the implicit bias training to see if it changes.
2) Structural issues within health care delivery are implicated in health care disparities. Please brainstorm 4 structural issues that might contribute to these disparities. Which of these are relevant to your particular area of research, and how?
Language Barriers: One of the issues related to access to lung transplantation is language barriers. Patients are evaluated on the basis of their medical literacy and their ability to learn and synthesize knowledge about language. If there are language barriers it makes it harder for them to understand and do a good synthesis information because the teaching is done in a foreign language. Additionally, if they do not have a good understanding of the language they will be unable to articulate their concerns related to the transplant.
Insurance Access: Access to insurance is paramount for patients who need lung transplantation. As noted above, they will be denied transplant if they do not have the right insurance. This is clearly a barrier.
Location/geographic Barriers: After transplantation, patients are required to stay in San Francisco for 6 weeks. Then, they are required to come back for frequent visits. If a patient lives near a transplant center they will have better access to the transplant center. Furthermore, if they happen to live in San Francisco they do not have to use flexible resources to fund their post-transplant care.
Access to flexible resources: As noted in the previous structural barrier patients need to be able to stay in San Francisco for a period of time after transplant. This 6 week mark is very expensive so having flexible resources makes this more likely. Furthermore, even after the 6 weeks there are medication decisions that are made based on the cost. If patients do not have flexible resources they may not get the meds they need.