Many experts today insist that bias in the doctor’s office will lead to poorer treatment of minority patients. A new monograph by Jonathan Klick of Florida State University and AEI’s Sally Satel, The Health Disparities Myth: Diagnosing the Treatment Gap (AEI Press, 2006) found no evidence to support the idea that racially biased doctors are a cause of poor minority health.

The notion of physician bias was popularized in 2002 by a report from the Institute of Medicine called “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.” It concluded that important dynamics in race-related treatment differences were “bias,” “prejudice,” and “discrimination” within the doctor-patient relationship. Klick and Satel argue, however, that most studies used to support this notion rely upon retrospective analyses of health-system databases which are often missing critical variables that affect doctors’ treatment decisions.
 
Differences in treatment do indeed vary by race but not because of it. People living in places with inadequate medical resources tend to receive poor care, whether they are black or white. The authors found that socioeconomic status and geographic location--not race--make a much greater difference in a person’s health and the quality of care he receives. As such, policy prescriptions to increase “cultural competence” do not make sense.

Geographic and socioeconomic factors generate most of the treatment gap. White and black patients, on average, do not even visit the same population of physicians, making the idea of preferential treatment by doctors a far less compelling explanation for health disparities than has been claimed.

According to Klick and Satel, the charge of bias is divisive and siphons energy and resources from efforts to improve minority health, such as expanding access to high-quality care and facilitating changes in individuals’ lifestyles and their capacity to manage chronic disease. From this perspective, proposed race-based remedies for the treatment gap become trivial or irrelevant at best, and potentially harmful at worst.

For the authors, a true public health solution to inadequate care would focus resources on improving the quality of care and self-care regardless of race.