Does race of doctors matter?
By Allison M. HeinrichsTRIBUNE-REVIEW
Saturday, March 21, 2009
Highmark Inc. is asking customers if they want doctors' race or ethnicity included in the health insurer's physician directory.
The company's automated telephone survey is raising concerns about the potential for racial profiling while garnering applause for attempts to reduce health care disparity.
"We know that patients who are African-American, for example, are more satisfied with their clinicians if their clinicians are African-American," said Dr. Bob Arnold, a University of Pittsburgh professor of medicine. "The thing that makes me feel a little funny about it is how far you could take it ... you might want to know if a doctor is a Democrat or Republican, or your doctor's religion. I think that would make us feel less comfortable."
Highmark has called about 3,500 customers so far and plans to contact up to 100,000. Nearly 30 percent of respondents have said that knowing a physician's race or ethnicity would be helpful in selecting a doctor, said Highmark spokesman Michael Weinstein.
The insurer is doing the survey because national studies show minorities do not receive the same quality of health care as whites, Weinstein said. The National Committee for Quality Assurance ranks health plans in part on how well they address disparity, which is one of the reasons Highmark decided to conduct the survey, he said.
"We haven't made any changes to our directory yet," Weinstein said. "But what we're trying to do, because this is a sensitive issue to some folks, is get feedback from our subscribers about whether this would be useful to them."
Highmark has several programs to address health care disparities, including improving access to fitness programs in predominantly black communities, creating culturally appropriate brochures and holding a conference to address the needs of minority women.
Dr. Douglas Clough, president of the Allegheny County Medical Society and an internal medicine physician with practices in the North Side and McCandless, said race should not be included in Highmark's or any other insurer's physician directory.
"Race and ethnicity should not be a part of a choice of physician. It should be qualifications, expertise and knowledge," Clough said. "This country prides itself on not discriminating against people of different ethnicity and race."
UPMC Health Plan and Aetna, both of which offer health insurance in Western Pennsylvania, do not list race in their physician directories.
"We've wrestled with the idea over the years," said Sandra McAnallen, vice president of performance and quality at UPMC Health Plan. "And if our members have a specific request for a physician of a specific race, we do outreach and assist the member with that selection."
One in five minority patients feels more comfortable with a minority physician, said Dr. Som Saha, associate professor of medicine at the Oregon Health and Science University in Portland.
"I'm, personally, in favor of the idea," said Saha, who has spent more than a decade researching the topic. "Although we would like to think we live in a color-blind society, we don't. Race does matter. ... And some people from minority backgrounds just feel more comfortable with doctors who share those backgrounds."
According to a 2004 report by Dr. Louis Sullivan, a former secretary of the Department of Health and Human Services, just 6 percent of physicians were black, Hispanic or American Indian, though those minorities made up more than 25 percent of the population at the time.
"If we think the answer is simply matching race or ethnicity-matching, then that's not going to work because there are simply not enough minority providers to serve all the minority patients," said Stephen Thomas, director of Pitt's Center for Minority Health. "We shouldn't let people believe that just because you aren't the race or ethnicity of your patient, you can't serve them."
About 12 percent of Pitt's School of Medicine student body is made up of minorities, and 14 percent of this year's entering class was minority.
"We find underrepresented students who have an interest in health care careers and make sure they have the academic grounding to be successful," said Paula K. Davis, assistant vice chancellor for diversity in the Schools of the Health Sciences. "We have baseline data showing us that racial and ethnic minority health care providers are more likely to serve minority communities."
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