26 Clearinghouse Rev. 159 (1992-1993)
Color of Money: Barriers to Access to Private Health Care Facilities for African-Americans, The; Butts, Cassandra Q.

handle is hein.journals/clear26 and id is 159 raw text is: National Health Law Program
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The Color of Money: Barriers to
Access to Private Health Care
Facilities for African-Americans
by Cassandra Q. Butts
I. Introduction
It is hard to separate the effects of discrimination
from those of concentration of Negroes in those
areas where medical facilities are not easily ac-
cessible and in those income brackets which do
not permit the purchase of medical facilities in
the competitive market. Discrimination in-
creases Negro sickness and death both directly
and indirectly and manifests itself both con-
sciously and unconsciously. Discrimination is
involved when hospitals will not take in Negro
patients; or when-if they do permit Negro pa-
tients-they restrict their numbers, give them
the poorest quarters, and refuse to hire Negro
doctors and nurses to attend them.
Ill health reduces the chance of economic ad-
vancement, which in turn operates to reduce the
chance of getting adequate medical facilities or
the knowledge necessary for personal care.1
In 1944, Gunnar Myrdal documented discrimination
against African-Americans in the United States and de-
scribed how the interrelation of race, poverty, and geog-
raphy constructs barriers to health care access. Almost
five decades after the publication of Myrdal's ground-
breaking work, American Dilemma, African-Americans
continue to lag far behind whites in key indicators of the
health of a people. Grim statistics show that access to
quality health care facilities continues to be a significant
problem for African-Americans. At the center of this
problem lies the virtual exclusion of African-Americans
from private health care facilities.2
1. GUNNAR MYRDAL, AMERICAN DILEMMA 174 (1944).
2. Private health care facilities are defined as both nonprofit
and for-profit facilities.

This article will discuss the barriers to access to
private health care facilities for African-Americans. It
will first present an overview of the issue from a historical
perspective and a construction of the problem today from
both a racial and an economic perspective. It will then
look more specifically at three issues involving private
health care facilities and discrimination against African-
Americans: hospital closures and relocations, emergency
room care, and nursing homes. Finally, it will discuss
existing law and public policy initiatives that might bring
down the barriers for African-Americans and others who
are discriminated against in obtaining health care.
II. The Private Problem: Then and Now
Private health care facilities have historically discrimi-
nated against African-Americans. Following the civil rights
movement and the removal of the most visible signs of
segregation, private health care facilities, like other private
institutions operating relatively free from the legal mandates
of desegregation, became the refuge of whites fleeing inte-
gration. Public health facilities and some nonprofit private
hospitals (run by charitable institutions, churches, and uni-
versities) served the health needs of African-Americans. In
rural areas, the care of African-Americans fell to commu-
nity health centers and in urban areas to large public hospi-
tals.3 African-American physicians, themselves the victims
of systemic discrimination in education and employment
opportunities, made up less than one percent of the physi-
cians in the nation and were the primary source of medical
3. See D. REITZES, NEGROES AND MEDICINE (1958); C. ODE-
GAARD, MINORITIES IN MEDICINE: FROM RECEPTIVE PASSIV-
ITY TO POSITIVE ACTION 1966-1977 (1977).

Clearinghouse Review-May/June 1992

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