IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v63y2006i10p2702-2714.html
   My bibliography  Save this article

The double burden on safety net providers: Placing health disparities in the context of the privatization of health care in the US

Author

Listed:
  • Horton, Sarah

Abstract

The US Institute of Medicine's (IOM) influential 2003 report has focused attention on disparities in treatment outcomes and health status for American minorities, zeroing in on the role of unconscious bias in the unequal clinical disposition of minority patients. In keeping with the IOM's focus, current examinations of health disparities in the US tend to explore bias in clinical decision-making to the neglect of the political economic trends that buffet health care safety net sites and create the need for financial shortcuts. This paper recontextualizes the study of health disparities in the US by placing it against the backdrop of private sector trends emphasizing fiscal austerity and increased workforce productivity in health care. The social science literature on workers in human service bureaucracies, only recently applied to health care workers, suggests that higher demands for system "accountability" and worker "efficiency" may encourage providers to take shortcuts by treating individuals as mass categories. This ethnography of a Latino mental health clinic in the Northwestern USA shows that new private-sector measures of "productivity" take a toll on both the Latina clinicians whose invisible work subsidizes the system as well as on particular categories of patients--the uninsured and immigrants with serious psychosocial issues. While clinicians attempt to buffer the impacts of such reforms on patients, they also resort to means to increase their productivity such as firing repeated no-show patients and denial of care to the uninsured. This study is relevant for the health care of the poor in all health care systems considering restructuring along managerial principles to increase system 'efficiencies.'

Suggested Citation

  • Horton, Sarah, 2006. "The double burden on safety net providers: Placing health disparities in the context of the privatization of health care in the US," Social Science & Medicine, Elsevier, vol. 63(10), pages 2702-2714, November.
  • Handle: RePEc:eee:socmed:v:63:y:2006:i:10:p:2702-2714
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(06)00353-4
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. van Ryn, Michelle & Burke, Jane, 2000. "The effect of patient race and socio-economic status on physicians' perceptions of patients," Social Science & Medicine, Elsevier, vol. 50(6), pages 813-828, March.
    2. Van Ryn, M. & Fu, S.S., 2003. "Paved with good intentions: Do public health and human service providers contribute to racial/ethnic disparities in health?," American Journal of Public Health, American Public Health Association, vol. 93(2), pages 248-255.
    3. Balsa, Ana I. & McGuire, Thomas G., 2001. "Statistical discrimination in health care," Journal of Health Economics, Elsevier, vol. 20(6), pages 881-907, November.
    4. Waitzkin, H. & Williams, R.L. & Bock, J.A. & McCloskey, J. & Willging, C. & Wagner, W., 2002. "Safety-net institutions buffer the impact of medicaid managed care: A multi-method assessment in a rural state," American Journal of Public Health, American Public Health Association, vol. 92(4), pages 598-610.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Smith, Sarah A., 2016. "Migrant encounters in the clinic: Bureaucratic, biomedical, and community influences on patient interactions with front-line workers," Social Science & Medicine, Elsevier, vol. 150(C), pages 49-56.
    2. Closser, Svea & Mendenhall, Emily & Brown, Peter & Neill, Rachel & Justice, Judith, 2022. "The anthropology of health systems: A history and review," Social Science & Medicine, Elsevier, vol. 300(C).
    3. Marrow, Helen B., 2012. "Deserving to a point: Unauthorized immigrants in San Francisco’s universal access healthcare model," Social Science & Medicine, Elsevier, vol. 74(6), pages 846-854.
    4. Mladovsky, Philipa, 2023. "Mental health coverage for forced migrants: Managing failure as everyday governance in the public and NGO sectors in England," Social Science & Medicine, Elsevier, vol. 319(C).
    5. Pillay, Timesh D. & Skordis-Worrall, Jolene, 2013. "South African health financing reform 2000–2010: Understanding the agenda-setting process," Health Policy, Elsevier, vol. 109(3), pages 321-331.
    6. Viladrich, Anahí, 2012. "Beyond welfare reform: Reframing undocumented immigrants’ entitlement to health care in the United States, a critical review," Social Science & Medicine, Elsevier, vol. 74(6), pages 822-829.
    7. Lo, Ming-Cheng M. & Nguyen, Emerald T., 2021. "Resisting the racialization of medical deservingness: How Latinx nurses produce symbolic resources for Latinx immigrants in clinical encounters," Social Science & Medicine, Elsevier, vol. 270(C).
    8. López-Sanders, Laura, 2017. "Changing the navigator's course: How the increasing rationalization of healthcare influences access for undocumented immigrants under the Affordable Care Act," Social Science & Medicine, Elsevier, vol. 178(C), pages 46-54.
    9. Zuberi, Daniyal M. & Ptashnick, Melita B., 2011. "The deleterious consequences of privatization and outsourcing for hospital support work: The experiences of contracted-out hospital cleaners and dietary aids in Vancouver, Canada," Social Science & Medicine, Elsevier, vol. 72(6), pages 907-911, March.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Felix C.H. Gottschalk, 2019. "Why prevent when it does not pay? Prevention when health services are credence goods," Health Economics, John Wiley & Sons, Ltd., vol. 28(5), pages 693-709, May.
    2. Lutfey, Karen E. & Link, Carol L. & Grant, Richard W. & Marceau, Lisa D. & McKinlay, John B., 2009. "Is certainty more important than diagnosis for understanding race and gender disparities?: An experiment using coronary heart disease and depression case vignettes," Health Policy, Elsevier, vol. 89(3), pages 279-287, March.
    3. Eric French & Elaine Kelly & Richard Cookson & Carol Propper & Miqdad Asaria & Rosalind Raine, 2016. "Socio‐Economic Inequalities in Health Care in England," Fiscal Studies, Institute for Fiscal Studies, vol. 37, pages 371-403, September.
    4. Hernandez, Elaine M., 2013. "Provider and patient influences on the formation of socioeconomic health behavior disparities among pregnant women," Social Science & Medicine, Elsevier, vol. 82(C), pages 35-42.
    5. Silvia Angerer & Christian Waibel & Harald Stummer, 2019. "Discrimination in Health Care: A Field Experiment on the Impact of Patients’ Socioeconomic Status on Access to Care," American Journal of Health Economics, University of Chicago Press, vol. 5(4), pages 407-427, Fall.
    6. Balsa, Ana I. & McGuire, Thomas G., 2003. "Prejudice, clinical uncertainty and stereotyping as sources of health disparities," Journal of Health Economics, Elsevier, vol. 22(1), pages 89-116, January.
    7. Varcoe, Colleen & Browne, Annette J. & Wong, Sabrina & Smye, Victoria L., 2009. "Harms and benefits: Collecting ethnicity data in a clinical context," Social Science & Medicine, Elsevier, vol. 68(9), pages 1659-1666, May.
    8. Lutfey, Karen E. & Campbell, Stephen M. & Renfrew, Megan R. & Marceau, Lisa D. & Roland, Martin & McKinlay, John B., 2008. "How are patient characteristics relevant for physicians' clinical decision making in diabetes? An analysis of qualitative results from a cross-national factorial experiment," Social Science & Medicine, Elsevier, vol. 67(9), pages 1391-1399, November.
    9. Moscelli, Giuseppe & Siciliani, Luigi & Gutacker, Nils & Cookson, Richard, 2018. "Socioeconomic inequality of access to healthcare: Does choice explain the gradient?," Journal of Health Economics, Elsevier, vol. 57(C), pages 290-314.
    10. Meeuwesen, Ludwien & Harmsen, Johannes A.M. & Bernsen, Roos M.D. & Bruijnzeels, Marc A., 2006. "Do Dutch doctors communicate differently with immigrant patients than with Dutch patients?," Social Science & Medicine, Elsevier, vol. 63(9), pages 2407-2417, November.
    11. Burgess, Diana Jill & Crowley-Matoka, Megan & Phelan, Sean & Dovidio, John F. & Kerns, Robert & Roth, Craig & Saha, Somnath & van Ryn, Michelle, 2008. "Patient race and physicians' decisions to prescribe opioids for chronic low back pain," Social Science & Medicine, Elsevier, vol. 67(11), pages 1852-1860, December.
    12. Drewniak, Daniel & Krones, Tanja & Sauer, Carsten & Wild, Verina, 2016. "The influence of patients’ immigration background and residence permit status on treatment decisions in health care. Results of a factorial survey among general practitioners in Switzerland," Social Science & Medicine, Elsevier, vol. 161(C), pages 64-73.
    13. Michael A Schillaci & Howard Waitzkin & E Ann Carson & Sandra J Romain, 2010. "Prenatal Care Utilization for Mothers from Low-Income Areas of New Mexico, 1989–1999," PLOS ONE, Public Library of Science, vol. 5(9), pages 1-4, September.
    14. Katz, Arlene M. & Alegría, Margarita, 2009. "The clinical encounter as local moral world: Shifts of assumptions and transformation in relational context," Social Science & Medicine, Elsevier, vol. 68(7), pages 1238-1246, April.
    15. Hideyo Tsumura & Wei Pan & Debra Brandon, 2024. "Exploring Differences in Intraoperative Medication Use Between African American and Non-Hispanic White Patients During General Anesthesia: Retrospective Observational Cohort Study," Clinical Nursing Research, , vol. 33(6), pages 470-480, July.
    16. Scoles, Brooke & Nicodemo, Catia, 2022. "Doctors’ attitudes toward specific medical conditions," Journal of Economic Behavior & Organization, Elsevier, vol. 204(C), pages 182-199.
    17. Millas Caputo Juan Francisco, 2024. "Statistical discrimination during the 1871 yellow fever epidemic in Buenos Aires," Asociación Argentina de Economía Política: Working Papers 4745, Asociación Argentina de Economía Política.
    18. Setti Rais Ali & Paul Dourgnon & Lise Rochaix, 2018. "Social Capital or Education: What Matters Most to Cut Time to Diagnosis?," Working Papers halshs-01703170, HAL.
    19. Fujishiro, Kaori & Xu, Jun & Gong, Fang, 2010. "What does "occupation" represent as an indicator of socioeconomic status?: Exploring occupational prestige and health," Social Science & Medicine, Elsevier, vol. 71(12), pages 2100-2107, December.
    20. Druckman, James N. & Levy, Jeremy & Sands, Natalie, 2021. "Bias in education disability accommodations," Economics of Education Review, Elsevier, vol. 85(C).

    More about this item

    Keywords

    ;

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:63:y:2006:i:10:p:2702-2714. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.