Discrimination in healthcare: racial, gender, and systemic disparities

¶ … healthcare services, many people could encounter some form of discrimination on the basis of their race, gender, or even sexual orientation. Discrimination in healthcare may seem like it is not something that is a major issue. However, it absolutely does come up in many situations, states and environments. Whether based on gender, religion, race or sexuality, discrimination happens at overt or implied levels all of the time. In other situations, there are huge disparities in healthcare outcomes from one group to another and many experts say that this can only come from systemic or sporadic instance of racism from the healthcare sphere, from society in general or a combination of the two. While most people get very good care, there are situations where the healthcare and/or government sectors fall short. It is important to note that although people are not always aware of this; there are various laws that seek to protect patients from differential treatment when seeking health care services. Specifically, patients are protected by Federal law from just about any kind of discrimination and are certainly protect ted by California law from just about any kind of discrimination.

2. Week 2 -- Literature Review

When researching this topic, so many types of discrimination were found that it is currently difficult to decide on one type among discrimination based on race, ethnicity, disabilities, gender or constitutionally unprotected discrimination based on the type of work. Consequently, the literature review is still eclectic but now also includes literature on sexual orientation bias.

a. Lillie-Blanton, M., Maleque, S., & Miller, W. (2008). Reducing racial, ethnic, and socioeconomic disparities in health care: Opportunities in national health reform. Journal of Law, Medicine & Ethics, 36(4), 693-702.

This is related to discrimination in healthcare because it focuses on the need for systemic changes to reduce discrimination. Health and Welfare policy tends to concentrate on reducing health care disparities at the provider level; however, system-wide reforms are needed to insure individuals, make healthcare more available in all geographic areas, use a more diverse workforce in providing healthcare, and encouraging best practices on the clinical level to reduce health care disparities (Lillie-Blanton, Maleque, & Miller, 2008).

b. Pirruccello, J. E. (2005). Contingent worker protection from client company discrimination: Statutory coverage, gaps, and the role of the common law. Texas Law Review, 84(1), 191-223.

This is an interesting and useful article because it focuses on a type of discrimination that is not classically protected by the Constitution: the growing class of contingent workers -- those who are not regular, full-time employees - in America who suffer in the lack of healthcare coverage and other normal employee benefits provided by client companies. These workers can belong to any race, ethnicity, gender identity or differing abilities but their existence as a transient workforce makes them vulnerable to falling through the cracks in health care coverage (Pirruccello, 2005).

c. Rothstein, M. A. (2015). Limiting occupational medical evaluations under the Americans with disabilities act and the genetic information nondiscrimination act. American Journal of Law and Medicine, 41(4), 523-567.

This article is valuable when discussing discrimination because many workers must undergo workplace medical evaluations to determine their fitness for the job. Because this area keeps evolving, the statutes and regulations protecting individual workers based on race, ethnicity, gender and disabilities are growing increasingly complex. This article explores the evolving, complex system of laws, and medical-ethics attempting to deal with the growing use of workplace medical evaluations (Rothstein, 2015).

d. Sheppard, V. B., Williams, K. P., Wang, J., Shavers, V., & Mandelblatt, J. S. (2014). An examination of factors associated with healthcare discrimination in Latina immigrants: The role of healthcare relationships and language. Journal of the National Medical Association, 106(1), 15-22.

This article is related to discrimination in healthcare because it addresses the specific types of discrimination endured by a quickly growing segment of the U.S. population: Latinas.

A number of them, particularly if they are foreign born, have very bad experiences in our healthcare system. This article explains the need for more research about the type, occurrence and frequency of discriminatory experiences in the system. It also explains the importance of good communications between patients and healthcare providers to improve the system, reduce discrimination and reduce even the patients' perceptions of discrimination in the American healthcare system (Sheppard, Williams, Wang, Shavers, & Mandelblatt, 2014).

e. Snead, B., Hsieh, P.-C., & Snethen, G. (2016). Sexual identity and discrimination: Creating a welcoming environment for sexual minority consumers. Therapeutic Recreation Journal, 50(2), 172-175.

This article shows the healthcare community's proactive approach to building and maintaining a welcoming environment for sexual minorities. Sexual minorities may delay or avoid addressing healthcare issues and even if they seek healthcare, they may withhold information from healthcare providers for fear of a negative reactions from healthcare providers. Experts have found that sexual minorities who reside in highly prejudiced communities experience 12 years earlier mortality than those living in areas where homosexuality is more commonly accepted. Consequently, the effect of sexual orientation discrimination in healthcare, and even the perception of discriminatory treatment, clearly impacts the health of sexual minorities. As a result, at least some sectors of the healthcare industry are fashioning a more openly accepting environment for sexual minorities to encourage their use of healthcare and their complete honesty with healthcare providers (Snead, Hsieh, & Snethen, 2016).

4. Week 4 - Cases

f. Guadalupe T. Benitez v. North Coast Women's Care Medical Group, Inc. et al., (2001) San Diego County Superior Court Case No. GIC 770165, Appellate Case No. DO 45438.

Guadalupe Benitez is a lesbian who was refused requested infertility treatments commencing in 1999 due to her doctors' religious beliefs. Her doctors are conservative Christians who assert the "religious freedom" to withhold care from Benitez that they customarily provide to heterosexual patients. Benitez filed suit in San Diego Superior Court in 2001, which ruled in her favor in 2004 based on a clearly religiously-neutral civil rights law banning discrimination in healthcare based on sexual orientation. North Coast and its fellow defendants -- the offending doctors -- appealed to the California Court of Appeals. Sixteen associations, including but not limited to the California Women's Law Center, the Gay and Lesbian Medical Association and California Latinas for Reproductive Justice, filed amici curiae ("friends of the court") briefs in support of Benitez. In 2005, the Court of Appeals ruled that trial court's decision in Benitez' favor was premature and that the trial court should first hold a trial about whether the doctors violated the civil rights law before deciding whether religion can provide a defense to a civil rights claim. Benitez appealed that decision to the California Supreme Court. Thirty healthcare-related associations filed amici curiae brief supporting Benitez while sixteen conservative groups filed amici curiae briefs supporting North Coast's assertion that religious belief/freedom should allow them to deny healthcare to Benitez. In 2009, the California Supreme Court unanimously ruled in favor of Benitez, based on Federal and State law prohibiting discrimination. In 2009, the Parties reached settlement for an undisclosed sum of money to be paid by North Coast et al. to Benitez (Lambda Legal, 2009). I agree with the Benitez decisions in the trial court and California Supreme Court. Refusing to give commonly furnished healthcare to an individual solely based on his/her sexual orientation is clearly discriminatory on its face. As such, it is immediately violative of Federal and State laws and regulations prohibiting discrimination in health care.

g. David King, et al. v. Sylvia Burwell, Secretary Of Health And Human Services, et al. (2015) U. S Supreme Court, 576 14-114

This case represents several attacks on the Affordable Care Act in which the Act's opponents argued that the ACA allows for only on state-established exchanges, and that the IRS regulation providing for subsidies on state-run exchanges as well as federal exchanges exceeded the authority granted by Congress (Lambda Legal, 2015). In effect, it would leave about 5 million Americans who obtained coverage through federal exchanges without their tax credits and, as a result, their health insurance coverage under the Affordable Care Act. Lambda Legal filed an amicus curiae brief in the U.S. Supreme Court because the denial of those tax credits (and probably healthcare insurance under the ACA) would chiefly leave low-income, rural, southern, Black HIV sufferers living in the 34 states refusing to establish their own exchanges without healthcare insurance and even more vulnerable to healthcare difficulties associated with HIV. The U.S. Supreme Court ruled that health insurance subsidies are available to residents of all states. I agree with the Supreme Court's decision, as health insurance subsidies were intended for all residents and denial of those subsidies would unduly affect people vulnerable to discrimination: blacks and gays. The impact of denying subsidies would allow unspoken but severe discrimination against protected groups by denying their healthcare coverage.

5. Week 5 -- Summary

When seeking healthcare services, many people could encounter some form of discrimination on the basis of their race, gender, or even sexual orientation. Fortunately, there are various laws that seek to protect patients from differential treatment when seeking health care services. Specifically, Federal and State laws focus on prohibiting discrimination in healthcare based on protected classes such as race, gender and sexual orientation.

The healthcare industry has discerned and studied discrimination in healthcare against various classes of people. Approaching discrimination from many different avenues, researchers have found that: system-wide reforms are needed to insure individuals, make healthcare more available in all geographic areas, use a more diverse workforce in providing healthcare, and encouraging best practices on the clinical level to reduce health care disparities; the growing class of contingent workers are vulnerable to falling through the cracks in health care coverage; the statutes and regulations protecting individual workers based on race, ethnicity, gender and disabilities are growing increasingly complex; Latinas, particularly if they are foreign born, have very bad experiences in our healthcare system; and the healthcare community is proactively building and maintaining a welcoming environment for sexual minorities to encourage their use of healthcare and their complete honesty with healthcare providers.

Both Federal and California laws and regulations deal with discrimination against all protected classes, including but not limited to race, gender and sexual orientation. Federal laws/regulations include the Affordable Care Act, the Age Discrimination Act and Title VI of the 1964 Civil Rights Act, all consciously prohibiting discrimination based on a patient's protected class. In addition, the State of California's laws and regulations following Federal laws and regulations, with the California Department of Health Care Services monitoring and enforcing the laws.

There are several notable cases regarding discrimination in healthcare. In Benitez v. North Coast Women's Care Medical Group, Inc. et al. the California Supreme Court ruled against so-called "religious freedom" as a reason to deny healthcare and in King v. Burwell the U.S. Supreme Court stopped a challenge to the Affordable Care Act that would have left millions of the most vulnerable U.S. residents -- poor, black, gay HIV sufferers - without health insurance subsidies and therefore without insurance. Discrimination in healthcare services is obviously a continuing challenge to providing adequate healthcare to all U.S. residents. However, researchers, courts and legislatures are increasingly addressing this gravely unjust denial of healthcare to some of our most defenseless patients.