PUBLIC POLICY
Addressing a systemic problem Why we need a “Patient’s Choice” law BY CHARLES E. CRUTCHFIELD III, MD
Here at home
n a recent article, “Institutional racism in medicine: It’s time for changes,” published in the July 2020 edition of Minnesota Physician (http:// mppub.com/mp-c1-0720.html), members of the Minnesota Association of Black Physicians offered a first-hand look at the experiences and challenges faced by Black and other physicians of color. Institutional racism in medicine, and in every part of society, is much deeper and more complex than what can be illustrated by individual experience. In health care it also has significant impact on issues such as access, policy, and reimbursement. It is an insidious concept that hides so plainly in sight that those who promulgate its agenda often have no idea that this is exactly what they are doing.
For all its remarkable attributes, Minnesota has recently gained national attention in a way we would prefer to avoid. Our state has the ignominious distinctions of both having the widest disparity in academic performance between White students and students of color and the highest health care disparity between White residents and people of color. How can a state with the nation’s top-ranked health care system, the Mayo Clinic, one of the nation’s best academic health centers at the University of Minnesota, and well-developed regional health care systems fail to deliver favorable medical outcomes to its communities of color?
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It is a topic beyond the scope of a single article, especially considering that many in health care claim it could never happen in their profession. In this article we will shed more light on this important issue by addressing one of the most critical factors that affect patients of color: health plan exclusion of physicians in good standing without cause.
The reasons are varied. While experts can point to several demographic and economic factors, the most obvious is that Minnesota is in the minority of states that still permit health plans to deny health coverage for care by specific physicians. This includes even those willing to accept the health plan’s negotiated rates. The health insurers need not give a reason, and, in fact, they find it advantageous to provide no reason at all. Interestingly, if a health plan actually gave a reason for denying a patient their choice of doctor, the doctor may then have the right to appeal the reason provided. Quite simply, for the excluded physicians, “No reason given” means “no right to appeal.”
When cultural connections equal better outcomes For centuries, American health care has failed—often deliberately—to prioritize the health care needs of Blacks and other non-White people. Much medical care is universal and can serve different ethnic and racial communities. However, we are gaining a better understanding of how patients attain measurably better health outcomes when they have access to a physician with a shared ethnic, racial, or cultural background.
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Recent reports by National Public Radio (https://tinyurl.com/mp-npr), research by faculty at top institutions including the University of California at Berkeley and Stanford University (https://tinyurl.com/mp-uc-stanford), and a new report from the University of Minnesota, “Research Brief: Black newborns die less when cared for by Black doctors” (https://tinyurl.com/ mp-umn-newborns), are building on the body of information supporting the benefits of this access. These and many other similar reports conclude that Black patients who are treated by a Black physician achieve better outcomes. Specifically, Black patients were more likely to pursue more intrusive preventative medical care when recommended. Patients report better empathy from and comfort with doctors who share cultural, ethnic, and racial characteristics with the patient. There are reasons for the better outcomes from a shared background between patient and doctor. These include the greater shared cultural identity of physicians of color to work with other people of color who are traditionally underserved and often live in economically depressed areas. They also have
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AUGUST 2020 MINNESOTA PHYSICIAN
