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?
Physicians contribute to health care disparities in several ways, but the most obvious I can think of would be two major ways:
- Personal psychology mediating the care of individuals/groups of patients, either through implicit/explicit biases, heuristic-driven decision making, and cost/benefit decision making. This has been examined to a certain extent, though possibly we could do more to mitigate these effects through automated prompting, behavior “nudging” techniques, and other strategies for reducing bias in decision-making.
- Physicians choose their area of specialty and geographic practice region based on a number of factors, but the desirability of the area certainly plays a role. This winds up shunting highly successful/well-trained physicians towards high SES areas of the country and away from areas that are most in need of medical care. This could certainly be offset to a certain extent by creating incentives to practice in low-income areas and reducing the financial repercussions of making the decision to take on additional low-income/Medicare 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?
- insurance/financial: underinsured and uninsured patients often find it difficult to access primary care; in my area of research (diabetes and cognitive aging), this definitely plays a large role in creating disparities among elderly patients in managing their diabetes and ultimately sets them up for worse outcomes in a number of different domains.
- location/geographic barriers: quality primary care is essential in the management of any chronic illness, but particularly in diabetes. Additionally, we have found that these patients do much better when under the care of a geriatrician, which is a luxury afforded mostly to those living in or near large urban areas.
- language barriers: older patients in the US are less likely than younger patients to speak fluent English, and this creates health care disparities in a number of ways – it reduces the availability of medical care, often causes critical mistakes in prescribing, and puts them at risk for abuse by a younger relative acting as a translator.
- health literacy/educational opportunity barriers: we find that number of years in school correlates with better health outcomes in diabetic patients, but this is primarily a reflection of the geographic location of the patient, indicating that there are opportunity disparities by school district/local culture.