Providers Attribute Racial Healthcare Disparities to Social, Economic Conditions.

Racial inequalities in health care is a persisting issue in the United States. Progress in addressing these inequalities requires healthcare providers’ commitment; however, engaging providers is dependent on their perception of the factors that contribute to the inequalities.

Now, a new study co-authored by a School of Public Health researcher has found that, in contrast to prior studies, providers were more likely to attribute inequalities to social and economic conditions than to individual patient or provider behaviors.

The findings, published in Inquiry, have broad implications for the best way to engage providers in disparities reduction.

“Overall, providers view racial/ethnic healthcare disparities as having multi-level causes, including social and economic conditions, provider behavior, and the healthcare system,” says co-author Barbara Bokhour, associate professor of health law, policy & management. “These findings suggest an openness among providers to a multi-level strategy to disparities reduction, which incorporates organizational, provider-focused, and systemic approaches, especially when these approaches are contextualized in terms of the social determinants of health.”

Although the causes of racial inequalities in access and quality of healthcare are complex, there is a consensus that healthcare providers contribute to the persisting inequalities. Previous research, however, has indicated that providers tend to consider patient factors as more important contributors to racial differences than provider factors.

“Past survey evidence demonstrates that providers tend to consider patient factors (such as patient preferences and behaviors) as more important contributors to racial differences in care than provider factors (such as bias or poor communication),” the authors wrote. “This reluctance to identify providers as playing a role in causing disparities is concerning, because as mentioned above, the workforce is an important target for disparity reduction efforts.”

The researchers delivered a short survey and conducted qualitative interviews with 53 health care providers at three Veterans Health Administration sites to understand providers’ perceptions of causes of racial healthcare disparities. Qualitative analysis identified differences in how providers defined the casual factors for racial inequalities.

The researchers found that providers attributed the causes of disparities more to social and economic conditions than to patients’ or providers’ behaviors. Moreover, participants who believed that providers contributed to the disparities were more likely to confront issues of racism, identify mechanisms of how disparities emerge, and look at patient-level factors in context, while others focused more on the contribution of social and behavioral attributes of patients. This suggests that certain providers may resist efforts to directly name and confront race and structural racism in health care and points to the need for further research to understand how to offer these providers insights into the experiences of patients of color.

Bokhour argues that the use of qualitative research methods allowed for this deeper interpretation of provider perceptions of the roots of inequality. “Quantitative surveys that measure ‘single-level’ causes of disparities—such as patient behavior versus provider behavior—miss the complexity of providers’ reasoning, that distinguishes different subgroups of providers,” she says.

The paper was was led by Sarah Gollust of the University of Minnesota.

—Salma Abdalla