Role of Minority Providers in Caring for the Underserved

90 Presentation ROLE OF MINORITY PROVIDERS IN CARING FOR THE UNDERSERVED STEPHEN N. KEITH, M.D., M.S.P.H. Health Polio/ Advisor U.S. Senate Committee on Labor and Human Resources Providing access το medical care for our nation's poor and underserved is a problem of growing significance and immensity. The 1980s have brought the most robust economic expansion in America's history. But the growing number of our citizens without health insurance casts a dark shadow over this prosperity. Our leaders boast of statistics that show more Americans employed than at any other point in history. These same leaders persistently ignore the growing disparities between medical-care haves and have nots— disparities that result in embarrassingly high rates of infant mortality and other preventable conditions. Background Attempts to address inequitable distribution of quality health care are not new. Medicaid and Medicare were developed in the early 1960s to open the door of access to medical care for all of our citizens. The neighborhood and community health center programs and the National Health Service Corps (NHSC) were developed in the late 1960s and early 1970s to provide systems and structures to improve access to medical care for the underserved. The considerable expansion in the number of providers in the 1970s, stimulated by federal dollars, represented an additional strategy in an effort to improve access to medical care. Despite these varied and expensive interventions, the medically underserved —those without the resources to gain access to private medicine— persist. The rising tide of the economic recovery has left at dry dock more than 37 million of our fellow citizens who lack health insurance.1 A deregulated, procompetitive medical care environment has not brought greater access. In fact, the ranks of the underserved are growing. Poverty has enveloped more families , elderly people, and young children. And as business has turned its attention to controlling the escalating costs of medical care, it has turned a deaf Journal of Health Care for the Poor and Underserved, Vol. 1, No. 1, Summer 1990 ___________________________Keiih_________________________9Ί_ ear to providing basic benefits for its work force. Ozzie and Harriet now worry whether they can afford expensive prenatal care and the delivery of a newborn, and the Golden Girls refuse to pay the bill for their fellow seniors' catastrophic illnesses. We have seen these problems, and they are real. As with many other problems, our nation's black and other minority citizens suffer disproportionately. Statistics documenting disparities in health status between minority and non-minority Americans are too numerous. And how often have we seen television documentaries on the crisis in access to medical care that feature dispirited black and brown faces waiting endlessly in hospital outpatient departments. Minorities are overrepresented among the uninsured, among those on Medicaid, among those without a regular physician , and among those suffering from poor health status as a result of lack of access to care. Role of minority providers What is the role of black and other minority medical providers in the context of this worsening state of affairs? What has been their historical role, and what new roles have they assumed in recent years? And finally, should minority medical providers, principally physicians, be expected to practice in minority communities, among minority patients, out of a special sense of ethnic responsibility? These questions are more than purely academic. They may provide insight into ways to improve the health status and access to medical care for our nation's minority citizens. Understanding these issues is important for the current health policy debate on how to improve the American medical care system. Before 1970, the delivery of health care in black and other minority communities had been left primarily to health professionals of the same ethnic background. Yet during the same period, blacks and other minorities were vastly underrepresented among physicians compared with their proportion in the general population. According to the 1970 census, blacks accounted for 11.1 percent or the U.S. population but only 2.1 percent of U.S. physicians. Only 2.9 percent of the students enrolled in U.S. medical schools were black, more than three-fifths of whom studied at Howard University and Meharry Medical College, two...