Shelley I. White-Means

The Institute of Medicine report, Unequal Treatment, asserts that conscious and unconscious bias of providers may affect treatments delivered and contribute to health disparities. The primary study objective is to measure, compare, and contrast objective and subjective cognitive processes among pharmacy, nursing, and medical students to discern potential implications for health disparities. Data were collected using a cultural competency questionnaire and two implicit association tests (IATs). Race and skin tone IATs measure unconscious bias. Cultural competency scores were significantly higher for non-Hispanic Blacks and Hispanics in medicine and pharmacy compared with non-Hispanic Whites. Multiracial nursing students also had significantly higher cultural competency scores than non-Hispanic Whites. The IAT results indicate that these health care preprofessionals exhibit implicit race and skin tone biases: preferences for Whites versus Blacks and light skin versus dark skin. Cultural competency curricula and disparities research will be advanced by understanding the factors contributing to cultural competence and bias.

Objectives: Previous studies have examined racial and ethnic disparities in the use of selective serotonin reuptake inhibitors (SSRI). This study aims to examine the economic implications of these disparities. Research design and methods: In this retrospective observational study, the study sample was adult survey respondents with a diagnosis of depression from the Medical Expenditure Panel Survey (2002–2003). SSRI use was measured as the number of times when SSRIs were obtained. The racial and ethnic disparities in SSRI use were examined employing a negative binomial model. The economic implications of disparities were explored using a linear regression with SSRI use as an independent variable. Interaction terms between the variable for SSRI use and dummy variables for racial and ethnic groups were included to explore whether the relationships between SSRI use and health expenditures differ across racial and ethnic groups. Results: The mean number of times of SSRI use was higher for non-Hispanic whites than non-Hispanic blacks (3.02 vs. 1.79; p < 0.05) and Hispanic whites (3.02 vs. 1.68; p < 0.05). These differences were still significant after adjusting for covariates ( p < 0.05). In the multivariate analysis, each time of SSRI use was associated with health expenditures of $301 higher. Neither dummy variables for racial and ethnic groups nor the interaction terms between these dummy variables and the variable for SSRI use were significant. Conclusions: The lower use of SSRIs among minorities compared to non-Hispanic whites is associated with lower health expenditures among minorities. SSRI may be a proxy for improved access to health care due to under-treatment of depression in general. The main limitation of this study is that its observational nature does not allow the researchers to determine whether the association between SSRI use and the increase in health expenditures is a causal effect.

Relative to whites, Hispanics and blacks are less likely to have employer health insurance coverage. We examine whether ethnicity or race affects employment in traditional jobs or in contingent and alternative work arrangements, and whether ethnicity or race affects insurance offer, eligibility, and/or enrollment, conditional on employment sector. Health insurance disparities relative to whites are more pronounced for Hispanics, primarily due to disparities in employment by firms that offer coverage. Eliminating racial/ethnic disparities in offers, eligibility, and takeup would increase insurance coverage rates of Hispanics in traditional jobs and of both Hispanics and blacks in contingent and alternative jobs.