What Causes Racial Health Care Disparities? A Mixed-Methods Study Reveals Variability in How Health Care Providers Perceive Causal Attributions

Abstract

Progress to address health care equity requires health care providers’ commitment, but their engagement may depend on their perceptions of the factors contributing to inequity. To understand providers’ perceptions of causes of racial health care disparities, a short survey was delivered to health care providers who work at 3 Veterans Health Administration sites, followed by qualitative interviews (N = 53). Survey data indicated that providers attributed the causes of disparities to social and economic conditions more than to patients’ or providers’ behaviors. Qualitative analysis revealed differences in the meaning that participants ascribed to these causal factors. Participants who believed providers contribute to disparities discussed race and racism more readily, identified the mechanisms through which disparities emerge, and contextualized patient-level factors more than those who believed providers contributed less to disparities. Differences in provider understanding of the underlying causal factors suggest a multidimensional approach to engage providers in health equity efforts.

Differences in COVID-19-Related Testing and Healthcare Utilization by Race and Ethnicity in the Veterans Health Administration

“…It is plausible, although we could not analyze this directly, that barriers to care in the private sector, including a lack of healthcare insurance coverage, perceptions of high cost or low quality at available non-VHA providers, and perceived racial and ethnic bias may have contributed to the relatively higher use of COVID-19-related care at VHA facilities by Black and Hispanic veterans. There is evidence suggesting that some veterans prefer to use VHA services over private sector alternatives even when given the choice and that this preference may be more prevalent among Black and Hispanic veterans [ 26 – 30 ].…”

Allostatic Load in Perimenopausal Women With Migraine

“…In addition, we need further studies to delineate the neural circuitries associated with sleep disturbances and their association with hormone replacement therapy and allostatic load. Moreover, future studies need to examine how much of the excess risk of high allostatic load is attributed to the various reasons for the disparities; low SES, discrimination, systemic racism, provider bias, individual sensitivity to race just to mention a few, among perimenopausal women with migraine (49).…”

Inequities in access to VA’S aid and attendance enhanced pension benefit to help Veterans pay for long‐term care

“…They may include unequal outreach and education about benefits as previously highlighted by the VA's Advisory Committee on Minority Veterans, 30 provider bias in referring Veterans to appropriate channels for the A&A application, and stereotypical attitudes about how minority Veterans may decide to spend this cash benefit. 31,32 These disparities may also be driven by differences in Veterans' social support to identify and advocate 33 for benefits as well as trust of healthcare professionals 34,35 that may influence reporting the need for assistance. This list is not exhaustive and should be more fully explored in future research.…”