Addressing racial inequities in health care: civil rights monitoring and report cards.
Addressing racial inequities in health care: civil rights monitoring and report cards.
复制标题
解决医疗保健中的种族不平等问题：民权监测和成绩单。
DOI：
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发表时间：
1998
影响因子：
4.2
通讯作者：
David Barton Smith
中科院分区：
文献类型：
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作者：
David Barton Smith
据报道，医疗保健使用方面存在巨大的种族不平等，引发了对歧视的担忧。从历史上看，卫生系统以其专业主导、自主、自愿的组织结构，给民权努力带来了特殊的挑战。美国法律上的种族隔离被 1954 年至 1968 年期间的激进诉讼和执法时期所取代，然后又进入了目前相对不活跃的时期。联邦资源和组织能力不断下降，以解决医疗保健环境中更微妙形式的歧视性做法，法院的解释越来越严格，以及缺乏对提供者进行统计监测的系统性机制，这些因素综合在一起，无法保证歧视不会继续在解释使用差异方面发挥作用。目前，在基于风险的融资驱动下，医疗保健正在迅速转变为综合服务系统，这既带来了新的机遇，也带来了新的威胁。对此类系统的充分监管、市场和管理对绩效的比较系统统计评估提出了新的要求。我的结论说明了当前监控此类系统性能的“成绩单”方法可用于监控、纠正和建立对公平待遇的信任。
Large racial inequities in health care use continue to be reported, raising concerns about discrimination. Historically, the health system, with its professionally dominated, autonomous, voluntary organizational structure, has presented special challenges to civil rights efforts. De jure racial segregation in the United States gave way to a period of aggressive litigation and enforcement from 1954 until 1968 and then to the current period of relative inactivity. A combination of factors--declining federal resources and organizational capacity to address more subtle forms of discriminatory practices in health care settings, increasingly restrictive interpretations by the courts, and the lack of any systematic mechanisms for the statistical monitoring of providers--offers little assurance that discrimination does not continue to play a role in accounting for discrepancies in use. The current rapid transformation of health care into integrated delivery systems driven by risk-based financing presents both new opportunities and new threats. Adequate regulation, markets, and management for such systems impose new requirements for comparative systematic statistical assessment of performance. My conclusion illustrates ways that current "report card" approaches to monitoring performance of such systems could be used to monitor, correct, and build trust in equitable treatment.