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

handle is hein.journals/clear26 and id is 159 raw text is: National Health Law Program 2639 S. La Cienega Blvd., Los Angeles, CA 90034, (310) 204-6010, FAX (310) 204-0891; 1815 H St., NW, Suite 705, Washington, DC 20006, (202) 887-5310 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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