The present health crisis for racial minorities in the United States can be traced back to 400 years ago when racial discrimination rooted in this continent. For this long period of time, minorities were exclusive from the so called "mainstream" health system. The most popular health care system in U.S. - managed care, has actually built in incentives which may encourage discrimination. Research shows that "the total family premiums have risen more than $2,700 in four years, a rate was four times faster than that for workers' earnings" ("Kerry" 2004). Another research also shows that "the health care cost is continuing to increase in 12.9 percent next year. The firms are likely to shift much of the difference to employees in the form of higher required contributions and co-payment fees, or by limiting their choice of insurance plans" ("Survey" 2004).Some interest groups, like politicians, hospitals, doctors, insurance companies claim that such problem is caused by the people who don't buy health insurances. They also blame the companies which didn't provide health insurance package for their workers. These interest groups suggest each people should responsible for their own health condition. However, they only see the surface of this issue, and didn't see the essential of this issue in a large social scale.In structural functionalist's perspectives, the health crisis is caused by the failure of social structure- the society could not provide equal access to health care for racial minorities. Vernellia R. Randall, a notable professor in the University of Dayton school of Law, states that "since 1975 minority health status has steadily eroded and there has been no significant improvements in the removal of barriers that are due to institutional racism" ("Institutional Racism" 1997). Institutional discrimination occurs when normal operations and procedures of social institutions result in unequal treatment of minorities. Because of institutional racism, minorities have less education and fewer educational opportunities. Minorities are disproportionately homeless and have significantly poorer housing options. Racial residential segregation contributes to the concentration of poverty in minority communities. All these place minorities in economical, political, and social disadvantages in society which lead to numerous barriers, such as lack of insurance, lack of money, inadequate location of health care facilities, lack of enforcement of federal laws and so on, to access adequate health care.First, minorities lack of economic access to health care. A disproportionate number of racial minorities have no insurance, are unemployed, are employed in jobs that do not provide health care insurance, disqualify for government assistance programs, or fail to participate because of administrative barriers. Research shows that more than 38.4 million Americans are uninsured with no economic access to health care, mostly are racial minorities. The health insurance in the United States is most often tied to employment, racial stratification of the economy due to other forms of discrimination has resulted in a concentration of racial minorities in low wage jobs. And these jobs are always without insurance benefits. For example in the film "John Q", the main actor John, who is a black steel worker with a child in his family, cannot qualify the health insurance for his child because his job doesn't include health insurance benefits. Eitzen and Zinn in their book "Social problem", states that "structural changes in the U.S. economy- the shift of employment from manufacturing to services, the rise in contingent and part-time employment, and the decline in union membership- have resulted in a decline in employment-related health insurance coverage" ("Social Problems", p.500). As a result, disproportionate numbers of the uninsured are racial minorities who are more likely with the low wages jobs.The welfare reform enacted in 1996 worsen the problem. It changed the structure of public assistance, resulting in a negative impact on women and minorities. One of the direct effects of welfare reform is reduction in the use of Medicaid by those who qualify due to an unawareness of eligibility requirements, resulting in an increased number of uninsured. A second effect has been that the subsequent increased poverty among those in need of assistance has caused a worsening of health status and an increased in the need for health care services. Gaps in health status and the absence of relevant health information are directly related to access to health care.Second, there are many racial barriers to access health care. Many hospitals discriminate by using patient referral and acceptance practice standard that limit access. These practices restrict the admission of African-Americans to hospitals, for example not having physicians on staff who can accept Medicaid patients; requiring pre-admission deposit as a condition of obtaining care; refusing to participate in programs to finance care for low-income patients not eligible for Medicaid, and many other practices of restriction ("Institutional Racism" 1997). Such practices have a devastating effect on minorities since they set up a high wall between standard hospitals and minority groups. They may completely prevent care where minorities have no access to other sources of care.Racial barriers to health care access are based, in a large part, on the unavailability of services in a community. Increasingly, hospitals that serve the minority communities are either closing, relocating or becoming private. In a study done between 1937-1977, researchers found out that the likelihood of hospital's closing was directly related to the percentage of African-Americans in the population. Throughout the 1980s many hospitals relocated from heavily African-American communities to predominantly European-American suburban communities ("Institutional Racism" 1997). This loss of services to community resulted in reduced access to African-Americans. Another devastating trend that affects the access of African-American to health care is the privatization of public hospitals. Eitzen and Zinn states that traditionally, hospitals in the United States have been nonprofit organizations run by churches, universities, and municipalities. Since the mid-1960s, however, private profit-oriented hospitals are growing rapidly ("Social Problems", p.520). By the 1960s, there are only 90 african-american hospitals remained. By the 1991, only 12 hospitals continued to "struggle daily just to keep their doors open". Because of the capitalism economic system in the U.S., non-profit hospitals cannot survive by competing with the for-profit hospitals. They either merged, converted or consolidated to the for-profit hospitals. As a result of closure, relocations, and privatization, many minority groups are left with limited, if any, access to hospitals.Minority groups seeking care at a private hospital may face "patient dumping". As Eitzen and Zinn state, "for-profit hospitals either turn away patients who cannot afford their services or they tend to switch them to public hospitals as soon as possible or they keep the poor away by not providing the services they most require, such as emergency room"("Social Problems", p.504). Although in 1986 congress passed the Emergency Medical Treatment and Active Labor Act which makes patient dumping illegal, limited enforcement of these legislative enactments makes patient dumping continue to be a problem. Also hospitals have found other "tricks" to dump the patient without invoking the statute, such as they reroute the patient before he/she arrives to their emergency room. Here is a typical example for this case: a parent called the University of Chicago Hospital after her baby went into cardiac arrest. But the hospital told the paramedics to take the child to another hospital even though it was only five blocks away. The child was taken to a hospital without a pediatric intensive care unit and had to be transferred to another hospital. The child died after admission to the second hospital. However, the court announced the University of Chicago Hospital had no responsibility for this tragedy and it didn't violate the law ("Institutional Racism" 1997). Another way is to close emergency room. The report by the National Association of Community Health Centers finds that "in 2002 there were 110.2 million visits to hospital emergency departments, up form 89.8 million in 1998. During this time, many hospital emergency rooms closed and there were 15 percent fewer than in 1998" ("Uninsured Patients" 2004). So many hospitals continued dumping patients, most of whom will be minorities because of their low socioeconomic status.What's more, discriminatory policies and practices also prevent minority groups from accessing health care, such as medical redlining, excessive wait times, unequal access to emergency care, deposit requirements as a prerequisite to care, and lack of continuity of care, etc. One significant example is a racially-neutral federal Medicaid policy that limits the number of beds a nursing home can allocate to Medicaid recipients. The effect of this policy is that fewer Medicaid resources are spent on nursing for minority populations even though minorities represent a larger portion of the Medicaid population and have more illness. Many other policies and practices we can find in our health care system are related to structural and institutional racial discrimination. Racial inequality in health care persists in the United States because the legal system has been particularly reluctant to address issues of racial discrimination that result from polices and practices that have a disparate racial impact. In fact, the federal laws explicitly allows for such discrimination as long as the institution can demonstrate "business necessity".In conclusion, the economy, political, and legal system are dysfunction and failed to provide minorities equal access to health care. The inequality in the institutions leads to the failure of the health system. There is no simple solution to the problem. Government should enact and enforce some policies that provide affordable quality health care for the public, advocate universal health insurance, train more accessible standard physicians, encourage cities to build facilities near the poor and educate minority groups about preventative health care. But most important is to eliminate institutional racism in order to assure economic access, political fairness, and legal justice of health care for everyone.Bibliography:1. Vernellia R. Randall. "Institutional Racism in U.S. Health Care". 1997.http://academic.udayton.edu/health/07HumanRights/racial01c.htm#N_70_2. D. Stanley Eitzen and Maxine Baca Zinn. "Social Problems" 9th edition. 2003.3. Reuters. "Uninsured patients flood emergency rooms". MSNBC News. Aug. 9, 2004.http://www.msnbc.msn.com/id/56517384. Adam Geller. "Survey: Health Care Costs Continue to Rise". MSNBC News. Aug 27, 2004.http://www.msnbc.msn.com/id/58330565. The Associated Press. "Kerry: Health Care System 'badly broken'". MSNBC News. May 10, 2004.http://www.msnbc.msn.com/id/49447646. The Associated Press. "Gaps Linger in U.S. Health Care". MSNBC News. Dec 22, 2003.http://www.msnbc.msn.com/id/37861557. Sociology 3 class notes, week 1.
