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1、 INSTITUTEPerceptions of Discrimination and Unfair Judgment While Seeking Health CareFindings from the September I I 28 Coronavirus Tracking SurveyDulce Gonzalez, Laura Skopec, Marla McDaniel, and Genevieve M. Kenney April 2021Inequities in health insurance coverage and access to care are well estab
2、lished (Artiga, Orgera, and Pham 2020; CDC 2013; Institute of Medicine 2003; Riley 2012; Shartzer, Long, and Anderson 2015). The mechanisms behind these inequities are complex and include interpersonal experiences of unfair treatment while seeking care, institutional barriers within health systems,
3、and structural barriers in non-health care domains that contribute to socioeconomic disadvantage (Bailey et al. 2017; National Academies of Sciences, Engineering, and Medicine 2017).1 Research shows that people are often discriminated against or treated unfairly in health care settings because of di
4、sabilities, gender identity or sexual orientation, and race or ethnicity (Bleich et al. 2019; Mays et al. 2018; Nong et al. 2020; Skopec and Long 2016). These patterns are concerning given that health care disruptions and suboptimal quality that result from unfair treatment can lead people to delay
5、or forgo care, to search fbr a new provider, and to experience adverse health consequences (Bird and Bogart 2001; Burgess et al. 2008; Mays et al. 2018; Skopec and Long 2016; Stark Casagrande et al. 2007; Trivedi and Ayanian 2006; Van Houtyen et al. 2005).Despite significant evidence of disparities
6、in health care access and outcomes, there are significant knowledge gaps about the role of perceived discrimination and unfair treatment, specifically while seeking carejn contributing to these disparities at the national level (Shavers et al. 2012). Other research institutions have fielded surveys
7、in recent years exploring perceptions of unfair treatment orComparison with Other SurveysWe also compared our results with those of other surveys conducted in 2020 that explored patients perceptions of discriminatory or unfair treatment while seeking care (table 2). Importantly, these other surveys
8、differed from the Coronavirus Tracking Survey in wording of questions, target population, survey mode, reference period, and sample size.TABLE 2Comparison of Survey Questions about Patient Perceptions of Unfair Treatment, Unfair Judgment, or Discrimination While Seeking Care Fielded in 2020Urban Ins
9、titute Coronavirus Tracking SurveyThe Commonwealth Fund and Harvard T. Chan School of Public HealthKFF/The Undefeated September 2020 Survey on Race and HealthKFFJune 2020 HealthTracking PollPew Research Center June 2020 American Trends PanelSurvey questionIn the last 12 months, have you ever felt th
10、at a doctor, other health care provider, or their staff judged you unfairly or discriminated against you because of any of the following?a) Your raceb) Your ethnicityc) Your genderd) Your sexualorientatione) Your gender identityf) A disabilityg) A health conditionDuring the past 12 months, do you be
11、lieve that (you/anyone living in your household) ever experienced discrimination when going to a doctor or health clinic?Was there a time in the last twelve months when you felt you were treated unfairly in the following places because of your racial or ethnic background?While getting health care fo
12、r yourself or a family member?Can you think of any occasion in the last twelve months when you felt you were treated unfairly in the following places because ofyour racial or ethnic background?While getting health care for yourself ora family member?Here are a few things that some people in the U.S.
13、 may have experienced because of their race or ethnicity and others may not have. Please indicate whether or not each has happened to you because ofyour race or ethnicity:Been treated unfairly when seeking medical treatment.Reference period12 months12 months12 months12 monthsEverTarget populationAdu
14、ltsages 18 to 64Adults age 18 and olderAdultsages 18 and olderAdults ages 18 and olderAdults ages 18 and olderPERCEPTIONS OF DISCRIMINATION AND UNFAlR JUDGMENT WHILE SEEKING CAREUrban Institute Coronavirus Tracking SurveyThe Commonwealth Fund and Harvard T. Chan School of Public HealthKFF/The Undefe
15、ated September 2020 Survey on Race and HealthKFF June 2020 Health Tracking PollPew Research Center June 2020 American Trends PanelSurvey modeSelf-administered, probability-based webTelephoneHybrid, telephone and probability-based webTelephoneSelf-administered, probability-based webField datesSeptemb
16、er 11-28,2020November 5-December 5 2020August 20-September 14,2020June 8-14,2020June 4-10,2020Sample size4,0072z1501,7691,2969,654Share reporting unfair treatment, judgment, or discrimination in health care,All adults: 5%/ Black: 11%，Hispanic/Latinx: 5%，White: 4%, Black adults: 19%，Hispanic/Latinx:
17、12%，All adults: 10%“ Black: 20%，Hispanic/Latinx: 19%/ White: 5%，All adults: 8%“ Black: 17%/ Hispanic/Latinx: 14%,White: 5%，All adults: 11%，Black: 31%，Hispanic/Latinx: 18%, White: 5%Sources： Urban Institute Coronavirus Tracking Survey, wave 2, conducted September 11-28,2020; Pew Research Centers Amer
18、ican Trends Panel”, Pew Research Centers, accessed March 11,2021, TOPLINE.pdPutm_source=link_newsv9&utm_campaign=item_312590&utm_medium=copy;KFF Health Tracking Poll-June 2020,w Kaiser Family Foundation June 26,2020, :/files.kff.org/attachment/Topline-KFF-Health-Tracking-Poll-June-2020.pdf;KFF/The U
19、ndefeated Survey on Race and Health/7 KFF and The Undefeated, September 2020, .Notes： KFF = Kaiser Family Foundation. In the KFF and Pew surveys, respondents saw questions about unfair treatment in health care as part of a series of settings (for example, other settings or situations included being
20、unfairly stopped by police or at a store while shopping), The Commonwealth Fund/Harvard survey question on discrimination in health care was only asked of respondents who reported they or someone in their household received health care in the past 12 months.PERCEPTIONS OF DISCRIMINATION AND UNFAIR J
21、UDGMENT WHILE SEEKING CAREUsing Urbans September 2020 Coronavirus Tracking Survey, we found a lower prevalence of perceptions of discrimination or unfair judgment in health care than other 2020 surveys. The most comparable survey, the Kaiser Family Foundation/The Undefeated September 2020 Survey on
22、Health and Race, found that 10 percent of respondents ortheirfamily members had been treated unfairly because of their race or ethnicity while seeking health care in the previous 12 months, including 20 percent of Black respondents. The Kaiser Family Foundation (KFF) June 2020 Health Tracking Poll f
23、ound similar results (8 percent of all adults reported having been treated unfairly because of their race or ethnicity, including 17 percent of Black adults), Although the prevalence of unfair treatment was higher in these surveys, the gap between Black and white adults was similar. In contrast, the
24、 Pew Research Center June 2020 American Trends Panel, which has a lifetime reference period, found that 11 percent of respondents had ever been treated unfairly because of their race or ethnicity when seeking medical care, including 31 percent of Black respondents.Estimates were less consistent acro
25、ss surveys for Hispanic/Latinx respondents (see table 1). Urbans Coronavirus Tracking Survey found that 5 percent of Hispanic/Latinx respondents reported unfair judgment or discrimination by a health care provider ortheir staff, compared with 4 percent of non-Hispanic/Latinx white respondents. In co
26、ntrast, the KFF/The Undefeated September 2020 survey found that 19 percent of Hispanic/Latinx adults reported having experienced unfair treatment while seeking care because of race or ethnicity, compared with 5 percent of non-Hispanic/Latinx white respondents. Similarly, the KFF June 2020 Health Tra
27、cking Poll found that 14 percent of Hispanic/Latinx respondents or their family members had experienced unfair treatment while seeking care because of their race and ethnicity, compared with 5 percent of non-Hispanic/Latinx white respondents. The Pew Research Center June 2020 American Trends Panel f
28、ound similar results (18 percent of Hispanic/Latinx respondents reported this type of unfair treatment, compared with 5 percent of non-Hispanic/Latinx white respondents). And, the Commonwealth Fund/Harvard survey found 19 percent of Black adults who had a health care visit in the past year reported
29、discrimination while seeking care, compared with 12 percent of Hispanic/Latinx adults.Several factors may explain the differences between our results and those of other 2020 surveys. For one, the Pew Research Center survey has a lifetime reference period, which is more likely to capture a greater pr
30、evalence of unfair treatment than a more restricted 12-month reference period. Further, the KFFZ Pew Research Center, and Commonwealth Fund/Harvard surveys all surveyed adults 18 and older, whereas Urbans survey only surveyed nonelderly adults (ages 18 to 64).The context for the survey questions als
31、o differed. The KFF surveys and the Pew Research Center survey asked about unfair treatment while seeking care because of race and ethnicity in the context of a broader survey including questions about the George Floyd protests and opinions about racial discrimination in the United States. In contra
32、st, questions about perceptions of discrimination and unfair judgment by health care providers or their staff included in our survey were surrounded by unrelated questions about the experiences of individuals and families during the COVID-19 pandemic. The Coronavirus Tracking Survey also did not def
33、ine ethnicity for respondents before the series ofquestions on experiences of discrimination and unfair judgment, which may have led to underreporting on this measure for Hispanic/Latinx adults.Additionally, the approach of the relevant questions differed. The June 2020 KFF and Pew Research Center s
34、urveys asked about unfair treatment in the health care system because of race and ethnicity, whereas the Coronavirus T racking Survey asked about unfair judgment or discrimination by providers or their staff for multiple reasons and allowed respondents to select all that applied. The Commonwealth Fu
35、nd/Harvard survey did not ask whether the discrimination experienced while seeking care was because of race or ethnicity. The reasons for unfair judgment and discrimination by health care providers or their staff in our survey were also broader, requiring respondents to identify the reason for the d
36、iscrimination or unfair judgment rather than offering an open yes/no question may have affected responses. In addition, the Coronavirus Tracking Survey question was narrower, focusing on health care providers and staff rather than all types of health care system interactions. Lastly, the Coronavirus
37、 Tracking Survey only focused on experiences of discrimination and unfair treatment for the respondent, whereas the KFF, Pew Research Center, and Commonwealth Fund/Harvard surveys also asked about family or household experiences.Overall, more research is needed to determine whether respondents view
38、discrimination, unfair treatment, and unfair judgment as interchangeable. In addition, it remains unclear where poor treatment is most likely to occur, and whether those locations are captured in each of the survey questions we examined. For example, unfair judgment when filling a prescription may n
39、ot be captured by the Coronavirus Tracking Survey, whereas the broader wording of the Kaiser Family Foundation and Pew surveys may prompt respondents to include such experiences.Notes1 Brigette A. Davis, Discrimination: A Social Determinant of Health Inequities/ 2020 Pew Research Centers American Tr
40、ends Panel/ Pew Research Center, accessed March 11,2021, s:/ pewsocialtrends.Org/wp-content/uploads/sites/3/2020/06/PSDT_06,12.20_protest.report- TOPLINE.pdf?utm_source=link_newsv9&utm_campaign=item_312590&utm_medium=copy; Liz Hamel, Audrey Kearney, Ashley Kirzinger, Lunna Lopes, Cai ley Munana, and
41、 Mollyanne Brodie,KFF Health Tracking Poll-June 2020/ Kaiser Family Foundation, June 26,2020, ; Liz Hamel, Lunna Lopes, Cai ley Munana, Samantha Artiga, and Mollyanne Brodie, KFF/The Undefeated Survey on Race and Health,“ Kaiser Family Foundation, October 13,2020, s:/ kff.org/report-section/kff-the-
42、undefeated-survey-on-race-and-health-main-findings/;Poll finds at least half of Black Americans say they have experienced racial discrimination in theirjobs and from the police/ Harvard T. H. Chan School of Public Health, October 24z 2017； .1 Brigette A. Davis, Discrimination: A Social Determinant o
43、f Health Inequities/ 2020 Pew Research Centers American Trends Panel/ Pew Research Center, accessed March 11,2021, s:/ pewsocialtrends.Org/wp-content/uploads/sites/3/2020/06/PSDT_06,12.20_protest.report- TOPLINE.pdf?utm_source=link_newsv9&utm_campaign=item_312590&utm_medium=copy; Liz Hamel, Audrey K
44、earney, Ashley Kirzinger, Lunna Lopes, Cai ley Munana, and Mollyanne Brodie,KFF Health Tracking Poll-June 2020/ Kaiser Family Foundation, June 26,2020, ; Liz Hamel, Lunna Lopes, Cai ley Munana, Samantha Artiga, and Mollyanne Brodie, KFF/The Undefeated Survey on Race and Health,“ Kaiser Family Founda
45、tion, October 13,2020, s:/ kff.org/report-section/kff-the-undefeated-survey-on-race-and-health-main-findings/;Poll finds at least half of Black Americans say they have experienced racial discrimination in theirjobs and from the police/ Harvard T. H. Chan School of Public Health, October 24z 2017； .
46、The reference period for the survey questions on discrimination and unfair judgment in health care overlaps with the pandemic, during which many patients did not seek care and providers curbed services to prevent exposure to the coronavirus. We asked respondents about the consequences of their exper
47、iences, including whether they delayed or did not get needed care, did not follow medical advice, sought a new provider, or filed a complaint. Because of sample size restrictions, we do not present estimates for these outcomes, but forthcoming work will explore them. Health Affairs (blog), February
48、25z 2020, .4 We use Hispanic/Latinxto reflect the different ways in which people self-identify. The US Census Bureau uses the term Hispanic/The terms white and Bgck refer to adults who do not identify as Hispanic or Latinx.5 We asked respondents separately whether they were discriminated against or judged unfairly because of gender or gender identity. We opted to combine responses into one measure (i.e” gender or gender identity) for simplicity.6 Respondents with multiple structurally disadvantaged identities or conditions may not be able to identify the specific reason they were judge