III. Interdisciplinary Solutions
As discussed in Part II of this article, people of color encounter several barriers to accessing health care: inability to pay for health care, including a lack of adequate insurance; a shortage of health care providers; cultural insensitivity and miscommunication with health care providers; and discrimination. In an effort to remove these barriers to health care, there are four areas of study that should be examined and integrated: economics, business, law, and medicine. By partnering people from these four areas of expertise, a comprehensive strategy can be developed to eliminate the role that a patient's race and ethnicity plays in one's ability to access health care. Of course, to ensure that the solutions developed are practical and feasible in light of each unique culture, people of color should be integrally involved in developing the solutions.
Economists should be consulted, because they can provide objective data that can be used to make the case for equalizing access to health care for all Americans, regardless of ethnic and racial background. Specifically, economists can help quantify the cost to society if we fail to remove barriers to health care, as well as the cost to society to remove the barriers.
Business people should be consulted to help develop economic wealth in low-income minority communities so that the people will have the economic means to pay for health care services. Business people can design programs to attract industry to the communities, so that there will be better paying jobs with good employment benefits such as health insurance. They can also provide job training to the people in the minority communities, so that the people have the skills needed to acquire better paying jobs with benefits.
Business people can also help reduce the shortage of health care providers available to people of color and their communities. Business people can do this by designing business models and educational programs that show administrators of health care facilities and providers how to grow and operate a successful business that serves the uninsured, underinsured, and minority communities. First and foremost, it must be remembered that health care delivery is a business. As such, the facility or practice must adhere to basic business practices. The facility or practice must provide high quality services. Additionally, the facility or practice must market itself to patients that have the ability to pay for services, as well as to those who do not.
A prerequisite to developing a successful business model to operate a facility or practice that serves the needs of racial and ethnic minorities is to overcome the assumption that only certain people, instead of all people, deserve high quality health care that is provided in the best environment possible. This means that the staff is knowledgeable, friendly, and service oriented. It also means that the facilities are aesthetically pleasing and well maintained.
It is imperative that facilities and practices located in poorer neighborhoods are operated to attract patients from all economic levels. This will ensure that the facility or practice receives reimbursement at all levels, high, middle, and low, instead of only low to non-existent reimbursement. A facility or practice simply cannot continue to operate with little to no revenue. Only facilities and practices that receive adequate reimbursement can routinely maintain their physical structure and equipment, comply with accreditation standards (facilities, operations, and residency programs), and provide appropriate compensation to the health care staff to attract and keep a highly qualified and caring staff.
Lawyers can help define what legal remedies exist to removing barriers to care, as well as the success and failures of those remedies. For example, lawyers can help eliminate discrimination and increase the number of health care providers accessible to people of color. Lawyers can help minority communities use Title VI of the Civil Rights Act of 1964 to combat intentional and unintentional discrimination that impedes access to care. For intentional discrimination, lawyers can bring suit on behalf of patients that are discriminated against. For unintentional discrimination that results in an adverse impact on minority communities, lawyers can help advocacy groups pressure the Office of Civil Rights of the Department of Health and Human Services to more actively monitor facilities that receive federal funds to ensure compliance with Title VI of the Civil Rights Act and to pursue complaints of discrimination by patients. Lawyers can also help minority communities combat unintentional discrimination that results in an adverse impact on the community by helping the community negotiate with the administrators and owners of health care facilities to avoid, eliminate, and reduce business decisions and practices that create barriers to health care. For example, if a health care facility decides to relocate, lawyers can help develop and present alternative plans to the administrators and owners for achieving their same goals.
Lawyers can also help reduce the shortage of health care providers that treat people of color by assisting educational institutions in their attempts to increase the number of providers that traditionally serve people of color-- underrepresented minority health care providers. Lawyers can help these institutions design race-conscious admissions programs consistent with the dictates of the Equal Protection Clause of the Fourteenth Amendment and Title VI of the Civil Rights Act. Lawyers can also help advocacy groups lobby against future anti-affirmative action legislation that prohibits efforts by educational institutions that actively seek to increase the number of underrepresented health care providers.
Physicians and other health care providers should be consulted to help develop courses to train providers to be culturally sensitive, and to encourage providers to serve communities that have provider shortages. To make health care providers culturally sensitive, diversity training should become an integral part of their training. These courses should be offered throughout the health care provider's professional development: during the educational training; the practical training, such as residency programs; and upon completion of training through continuing education. These courses should be designed to expose and eradicate conscious and subconscious prejudicial and stereotypical thinking about racial and ethnic minority groups. It is also important that health care providers be routinely educated about the need to provide health care to patient populations that consistently suffer from health care provider shortages and the nobility of providing services to these communities.
Health care providers can also identify the unique health care problems of various ethnic and racial populations. Once the problems have been identified, the providers can then assist in the development of best practices to prevent and treat the problems. One example of a prevention technique is to better educate the respective ethnic and racial populations on the health issues disproportionately affecting them. Educational information should include the warning signs and symptoms of diseases, as well as information on healthy lifestyles, well-balanced diets, getting well-baby check-ups and physicals, etc. Health care providers can also facilitate prevention and treatment of disease by educating communities on how to select the appropriate health insurance when a patient has a choice of insurance plans. As already stated, the communities being assisted should be consulted in the development of preventative and treatment solutions to ensure that the solutions developed, although well intended, are not misguided in light of cultural differences.
In conclusion, developing solutions to improve access to health care for people of color requires the development of a health care system that adequately responds to the needs of a socially and culturally diverse population. Looking at the barriers to health care faced by several racial and ethnic groups-- African Americans, Asians Americans, Hispanic Americans, and Native Americans-- reveals the true prominence that color and ethnicity play in accessing health care in the United States. Understanding this dynamic is critical to developing an effective solution, because effective solutions can only be developed once the problem is clearly defined.
To form a comprehensive solution that removes the barriers to health care encountered by people of color requires a close examination of the barriers encountered by each group. Developing a comprehensive solution is ideal because it promotes an integrated, collective response that efficiently deploys resources to eradicate access issues. Additionally, taking an interdisciplinary look at the problem (economics, business, law, and medicine) is likely to result in an approach that is not only practical and feasible, but also economical.
. Legal Writing Instructor, Howard University School of Law. B.B.A, Emory University. J.D., George Washington University Law School..
