System Factors in Healthcare Disparities

Edward A. Rose, M.D.


Healthcare disparities result from a variety of factors such as access to care, insurance coverage, transportation, and funding. These factors result in unequal care between groups of people. Those with better access to care, effective insurance, available transportation, and a well-funded health care system receive better care. It is also noted that those who receive better quality care also tend to have an overall better quality of life. An understanding of healthcare disparities can help to understand inequitable treatment and living conditions for many subsets of the population.

The open discussion of healthcare disparities was brought to the forefront by the Institute of Medicine’s (IOM) report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.1 This report described many of the variables that affect distribution of care and made recommendations on how to eliminate such variables. Many of those variables still exist today despite concerted efforts of health care providers, academicians, and policy-makers. Much more work is needed to create a system that consistently delivers high-quality care to all.

Fragmented Systems

Healthcare in the US is delivered by a fragmented system, with wide variations in the quality and access to care across components of the system. One of the most significant obstacles is the lack of access to timely medical care. The recent Affordable Care Act (“Obamacare”) was an attempt to remove some of the challenges of affordability for all. However, it remains unclear whether payer-based changes actually improve outcomes including patient satisfaction.

There are also variations in the quality of care available to different populations. Some healthcare systems that were established to serve people of lower socioeconomic status may not provide evidence-based, national guideline-drive care that is individualized and patient-centered. Lack of funding for such agencies may preclude hiring the highest quality of staff and using the latest systems of care.2

Healthcare access habits of subsets of patients may reflect a poor understanding by those patients. Some present themselves to local Emergency Departments for minor illnesses and injuries simply because the Emergency Department is within walking distance of home. This makes the line longer in the ED for people with more pressing needs for care. In contrast, some subgroups may feel that even serious ailments are best handled at home or fear for a bureaucratic intervention by the healthcare system that could uproot them or their family. Those patients may wait at home instead of seeking care. Patient education is needed to inform people about the benefits of preventive care, early intervention, and healthy living.

Evaluation of quality of care is challenging in any system. Evidence-based care driven by nationally-established guidelines should be the focus of every healthcare system.2 Quality of care initiatives that extend to systems as a whole down to individual providers are important to the provision of excellent care to all patients who present for care as well as an understanding of where quality gaps might exist for certain groups of patients. Data-driven decisions can only help improve the system of care for all comers.


1Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. Journal of the National Medical Association. 2002 Aug;94(8):666.

2Trivedi AN, Nsa W, Hausmann LR, Lee JS, Ma A, Bratzler DW, Mor MK, Baus K, Larbi F, Fine MJ. Quality and equity of care in US hospitals. New England Journal of Medicine. 2014 Dec 11;371(24):2298-308.

3Fiscella K, Sanders MR. Racial and ethnic disparities in the quality of health care. Annual review of public health. 2016 Mar 18;37:375-94.