Race Key Factor in Unfair Treatment of Parents and Children in Healthcare Settings, Study Finds

Researchers find that unfair treatment of parents and children in healthcare settings is linked to care disruptions such as delayed or foregone care.

Black parents are about twice as likely as parents who are White, Hispanic/Latinx, or of other races to experience unfair treatment in healthcare settings, according to a new study.

Earlier research has documented discrimination or unfair treatment based on race, ethnicity, and other personal characteristics. In healthcare settings, discrimination or unfair treatment has been linked to negative consequences for healthcare access, healthcare quality, trust in the healthcare system, and treatment adherence.

The new study, which was conducted by the Urban Institute, is based on data collected from parents with children under the age of 19. The data was drawn from the June 2022 Urban Institute Health Reform Monitoring Survey. That survey had a sample size of 9,494 adults.

The study features several key findings:

• 13% of parents said they were treated unfairly in healthcare settings based on race or ethnicity, language, health insurance type, weight, income, disability, or other characteristics
   
• 22% of Black parents said they were treated unfairly in healthcare settings, which was 10 percentage points higher than unfair treatment reported by parents who were White, Hispanic/Latinx, or additional races
   
• 3% of all parents said that their children were treated unfairly in healthcare settings because of the parent's or child's race, ethnicity, country of origin, or primary language
   
• 9% of Black parents said that their children were treated unfairly in healthcare settings because of the parent's or child's race, ethnicity, country of origin, or primary language
   
• 71% of parents who reported unfair treatment said they experienced disruptions in their healthcare
   
• 40% of Black parents and 30% of Hispanic/Latinx parents said they were concerned that they or a family member would be treated unfairly in healthcare settings in the future because of race, ethnicity, or primary language
   
• Black parents were more likely than White parents to be treated unfairly based on health insurance type (9% versus 4%); weight (8% versus 5%); gender, gender identity, or sexual orientation (9% versus 4%); income level (6% versus 3%); or disability or health condition (5% versus 3%)

Interpreting the data

Healthcare organizations should find the research alarming, Dulce Gonzalez, a research associate at the Urban Institute's Health Policy Center and co-author of the study, told HealthLeaders. "It is a concern because all people regardless of their background and regardless of their personal characteristics deserve access to respectful and high-quality care. It is concerning to us that not everybody—particularly people of color—is getting that kind of treatment in healthcare. It points to systemic issues in the healthcare system, including both implicit and explicit systemic biases as well as policies that are systemic to the healthcare system that allow for racism, classism, and ablism."

The findings are "striking," she said. "People of color and especially Black parents reported feeling treated unfairly at much higher rates than White parents. Among Black patients, the rates of unfair treatment among children specifically are much higher than those of other races and ethnicities. Notably, rates of unfair treatment for parents with the youngest children are just as high as parents with older children. That is significant because young children are going through an intense period of development, and exposure to negative experiences in healthcare early on in life is particularly concerning."

Unfair treatment has negative consequences for patients, Gonzalez said. "It is concerning that these experiences of unfair treatment have the potential to affect healthcare access generally. When people told us that they experienced unfair treatment, many people reported they also experienced disruptions to care such as delayed or foregone needed care, switching providers, and not following providers' recommendations, which speaks to the breakage of trust between patient and provider. Based on prior research, we know that unfair treatment can be associated with higher levels of stress and adverse mental health outcomes."

These care disruptions have short-term and long-term effects on patients, she said. "It is possible that if people are not getting needed healthcare that they are also not able to get preventive care, routine care, or primary condition management care in the short-term. It is also possible that not getting these kinds of care could have a negative effect on health in the long-term."

Addressing unfair treatment of patients

Several steps can be taken to reduce the unfair treatment of patients based on personal characteristics, Gonzalez said. "You can uncover and address the implicit and explicit bias that exists among providers and their front-office staff. You can also make broader changes to the healthcare system to improve the experiences of people of color such as diversifying the healthcare workforce along race, ethnicity, and other dimensions to help build trust between providers and their patients. Another avenue is expanding on community programs, which can leverage community expertise to help bridge communication and trust gaps for people of color."

A pair of government programs should be focal points in efforts to address unfair treatment of parents and their children based on personal characteristics, she said. "You could leverage Medicaid and the Children's Health Insurance Program, with the acknowledgement that these programs serve a large number of children. Being able to leverage those programs to reward providers who are excelling at providing high-quality and respectful care could be a powerful incentive to promote better treatment of patients."

Related: Online Reviews Reveal Patterns of Discrimination in Hospital Setting