Kam Shaw of Contra Costa County is just one example of a black Californian who feels underserved by our healthcare system.
In July, Shaw, whose name was changed to protect her medical privacy, tried to get an urgent appointment because of pain in her foot. The pain escalated over the course of two days. On the third day, she called her doctor’s office at 6 a.m., hoping to get an appointment that same day. She didn’t hear anything until 4:00 pm, when she was in extreme pain and could barely walk.
Shaw had to make an expensive trip to the emergency room but received no diagnosis. Instead, she was sent home with medication and a bandage, with instructions to contact her primary care provider in 5 to 7 days if she was still in pain. Shaw never received any additional follow-up care or information about her foot injury from the hospital or her doctor. Ultimately, Shaw’s foot recovered on its own, but she felt like nobody cared to help her even though she had health insurance.
Black Californians have one of the lowest life expectancies in California and face disproportionately higher COVID-19 death rates. This is despite the fact that the vast majority of these residents have some form of insurance coverage and consistently show a keen interest in taking care of their health. This contradiction begs the question: what is wrong with health care for black Californians?
Recently, the California Health Care Foundation conducted 100 in-depth interviews with Black Californians to find out what challenges they face navigating the health care system. Responses highlighted several key issues, including a lack of respect from providers, discrimination based on the type of coverage, and missed diagnoses because providers ignored them.
The anecdotes from the report serve as poignant examples of how discrimination and bias in the healthcare system can negatively impact health. One Bay Area resident said he prefers black doctors because he feels those providers are more likely to listen to him. Other respondents bemoaned a shortage of black mental health professionals, saying this hampered their ability to find therapists to connect with. Some said they simply wanted to find a competent and compassionate provider, regardless of race.
Black Californians already face structural barriers to staying healthy because of their legacy of racism, including disproportionately high rates of poverty and lack of access to healthy food and green space.
Importantly, the report also highlights positive outcomes, including high levels of health insurance coverage among respondents, a significant interest in maintaining health, and an interest in building relationships with providers.
Another challenge Shaw faced was finding a vendor she was comfortable with. Throughout our conversation, she constantly commented on how she was struggling to find a black doctor to replace her previous doctor who recently retired. Shaw had positive experiences with this doctor and felt accepted and heard as a Black woman.
Shaw’s experience highlights a major problem in California’s healthcare system, a lack of black providers to meet the needs of black patients. Research shows that patients who are cared for by providers with a shared racial identity tend to have better communication and a higher quality of care. This provider shortage, coupled with limited accountability for health care systems that fail to adequately meet the needs of black patients, are structural factors that can have major implications for black patients. They go beyond the issue of bias or racism between individual vendors.
“We spun our wheels … tried to make people aware of their own implicit biases and think that would help without changing the system around them,” Katherine Haynes, a senior program officer at California Health, told me Care Foundation when referring to the focus on bias and discrimination against individual healthcare providers.
California is working to address this, Haynes said. She noted the efforts of Covered California and the California Department of Health Care Services to hold health plans accountable when they fail to take action to address unfair health outcomes in their patients. To do that, state health officials need more information about how black patients experience care. Healthcare providers can gather this information by routinely asking patients for feedback on the care they receive and efforts to improve their experience, Haynes said.
The means to gather this information already exist. The statewide Office of Health Care Access and Information, a division tasked with empowering the California workforce and expanding access to quality health care, collects key racial and ethnicity data, as well as information on health care quality and patient access.
A combination of state law and existing regulations requires the department to collect aggregate information about the quality of care given to black patients. These include Assembly Bill 1204, signed last year, which requires the state to develop and maintain a health equity reporting program with annual equity data from California hospitals. I encourage policymakers and regulators to monitor the data closely to identify recurring injustices affecting black patients and take action to fill larger gaps.
Acting on the data and implementing solutions will be the key to progress.
Ultimately, the goal is to collect the data needed to show how well the plans are performing in relation to the needs of their black patients. Beyond collecting data and developing performance metrics, I support efforts to empower the California healthcare workforce to ensure that one day black patients will no longer have to struggle to seek out providers who look like them.
As I spoke, one thing became clear: Black Californians like Shaw want to build lasting, positive relationships with their healthcare providers. They want more respect and partnership. California’s healthcare system must answer that call.
Denzel Tongue writes a column for the California Health Report on the intersection of racial justice, public policy and health justice. A native of Oakland, he works in public health and holds a master’s degree from the Goldman School of Public Policy at UC Berkeley.
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