Who Is Accountable for Racial Equity in Health Care?

Inadequate funding perpetuates segregation of African-American patients within the U.S. health care system. Eighty percent of African-American Medicare beneficiaries receive treatment from just 20 percent of physicians.

This commentary reviews the general economic circumstances that define the U.S. health care system as they relate to African-American patients. African-American patients tend to lack coverage and rely on Medicare at higher rates than white patients. Since patient insurance status largely determines revenue levels, hospitals and community health centers (CHCs) that serve African Americans face lower operating margins and cannot easily raise capital. Thus, within the market-based system, a "racial payer gap" cordons off certain health care organizations from the wealth of the nation's economic resources.

Key Findings:

  • Operating margins in hospitals where the majority of patients are nonwhite are 4 percent lower than nationwide averages.
  • While underfunded organizations attract skilled physicians, these centers cannot round out staffs with equally talented specialists and nurses.
  • In California, third-party providers have assisted organizations that lack adequate information technology capabilities.

De facto segregation of African-American patients is a widespread characteristic of the U.S. health care system. This article also describes successful models for providing financial and technical assistance to hospitals and centers that treat African Americans.