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 may contribute to health disparities as a result of their conscious or subconscious biases about the patient. Even though one expects physicians to be aware about the various cultural and sociodemographic differences that they may encounter during their practice and to treat these patients in an unbiased manner, the reality is that all humans universally apply stereotypes when making sense of other people and physicians are not immune to this phenomenon. As such, their beliefs about the patient and the racial/ethnic or sociodemographic group to which the patient belongs may directly influence their interpersonal behavior and their clinical decision making, which can then impact the health outcomes of the patient, resulting in health care disparities. In addition, poor understanding and lack of training regarding cultural sensitivity in practice ay contribute to health care disparities.
In the case of mental health, it is estimated that 25% of the US population lacks access to adequate mental health care and much of these mental health care disparities have been a result of the race/ethnicity, gender or sexual orientation of the patients. To examine whether some of this health disparities could be due to the effect of individual physicians and their implicit (or explicit) biases, observational studies such as the ones described in the AJPH article could be conducted, where different groups of providers could respond to the two identical scenarios respectively: one involving a White individual and one involving a member of a racial minority group (eg. Black). The providers could then be asked to clinically evaluate the behaviors and symptoms of the individual, with the intention to see whether the providers rate the individuals differently according to their race. In order to decrease the effect of individual physicians on health disparities, it is essential to conduct such research and to develop and implement programs and policies based on this research to empower minority groups. It is also important to increase funding for training the physicians to become more culturally competent to deal with a diverse array of patients.
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?
Access to insurance: Lack of insurance or underinsurance is a major obstacle when it comes to accessing health care. In some cases, an individual’s insurance may not cover mental illnesses. Even for people with insurance, high deductibles and co-pays make it difficult to afford.
Language barriers: Communication between the provider and the patient is crucial when it comes to diagnosing mental illnesses. It is known that there is an insufficient number of providers who speak languages other than English. As such, for patients who do not speak English, it becomes even more difficult to access proper mental health care. Indeed, linguistic difficulties among patients and differences in how they express symptoms of emotional and psychological distress may contribute to misdiagnosis and health disparities.
Geographical barriers: Many patients (especially those in the rural regions) may not live close to mental health care facilities from where they can seek more specialized care. For them, transportation issues, difficulty finding childcare and taking time off work act as added deterrents when trying to go to see their providers. In addition, those with mental health disorders more likely to have a lower SES so it would be even tougher for them to pay for the added childcare and transportation and to take time off of work, which may even threaten job security if done frequently. As such, the reluctance to seek health care due to such geographical barriers is understandable.
Cultural barriers: This includes the stigma associated with mental illness in many minority groups as well as the lack of culturally competent providers. In particular, the stigma, fear and negative attitudes associated with mental illnesses that is prevalent in most minority groups may prevent them from seeking and receiving health care. In addition, in many cultures, there is a distrust of health care providers which may also result in these individuals being less likely to seek the required health care.