MedicalResearch.com Interview with:
Lucy Schulson, MD MPH
Section of General Internal Medicine
Boston University School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Research in the early 2000s in California demonstrated that racial and ethnic minorities, immigrants, and those with limited English proficiency (LEP) experienced high rates of discrimination in healthcare. Since those studies were published, California has made concerted efforts at the state and local level to address health equity; these efforts may have impacted perceptions of discrimination in health care. However, it is not known how perceptions of discrimination in healthcare have changed over the last ten years overall and for specific groups. This study sought to compare perceptions of discrimination in health care in 2003-2005 compared to 2015-2017 overall, for racial and ethnic minorities, among immigrants, and among those with Limited English Proficiency (LEP).
MedicalResearch.com: What should readers take away from your report?
Response: Perceptions of discrimination in healthcare have decreased by about 50% overall when comparing more contemporary rates to 2003-2005 rates. However, this decrease was only significant among self-identified Latinos, immigrants, and those with LEP. Notably, African-Americans continue to perceive high rates of discrimination in healthcare– about 1 in 10 (10%) reported recent discrimination in healthcare.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future studies need to examine why Latinos and immigrants have experienced a decrease in perceived discrimination in health care in California while African Americans have not. Additionally, it important to see if these trends continue into the future, particularly if the broader political context changes. Finally, as health care discrimination is associated with poor health outcomes it is critical to continue to create interventions to address discrimination in health care.
Our findings differ from those of another study with a national patient sample that found that African American were reporting less discrimination, while Latinos were not.1 Our findings may be specific to California, which has undertaken specific steps to improve care for immigrants and for patients with limited English proficiency. We need more research to understand what has worked in California — -and what still needs to be done.
- Nguyen TT, Vable AM, Glymour MM, Nuru-Jeter A. Trends for Reported Discrimination in Health Care in a National Sample of Older Adults with Chronic Conditions. J Gen Intern Med. 2018;33(3):291-297. doi:10.1007/s11606-017-4209-5
Schulson LB, Paasche-Orlow MK, Xuan Z, Fernandez A. Changes in Perceptions of Discrimination in Health Care in California, 2003 to 2017. JAMA Netw Open. Published online July 03, 20192(7):e196665. doi:10.1001/jamanetworkopen.2019.6665
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