Passage
Both institutional and interpersonal factors contribute to persistent disparities in health outcomes for minorities in the U.S. In Study 1, researchers sought to categorize the major factors contributing to the disparity by surveying 2,000 African American and 3,000 Hispanic residents in a major metropolitan city. Of those surveyed, 64% met federal guidelines for living at or below the poverty threshold even though 90% of those surveyed were employed. When asked, "What prevents you from going to the doctor?" the most common responses were financial considerations (92%) , inability to get time off from work for appointments (85%) , lack of transportation (52%) , difficulty communicating with the health care provider (51%) , and fear/distrust of the health care system (48%) .Interpersonally, patients tend to fare better when their physician is of their same racial or ethnic background. Study 2 observed all Hispanic patients (n = 110) who visited a clinic in an urban lower-income community over one week. Patients met with either a Hispanic physician (n = 43) or a white, non-Hispanic physician (n = 67) . The Hispanic physician saw the patients who visited the clinic on Monday or Tuesday, and the white, non-Hispanic physician saw the patients who visited the clinic on Wednesday, Thursday, or Friday. Both physicians were men who spoke Spanish fluently, had been working at the clinic for 8-10 years, and were unaware of the study's purpose beforehand. This study collected data on the duration of the face-to-face appointment time with the physician, medication adherence one month after the appointment, and the number of symptoms disclosed to the physician by the patient. Ninety-eight of the patients were already on medication or were prescribed new medication at the time of their appointment, and patients were contacted one month later for assessment of adherence. The results of this study are shown in Figure 1.
Figure 1 Average appointment time (minutes) , medication adherence (percent) , and number of symptoms disclosed according to patient-physician ethnic discordance vs. concordance
Adapted from W. Yost, (C) 2007 Academic Press.
-Which of the following concepts LEAST helps to explain the results of Study 1?

Question

Passage
Both institutional and interpersonal factors contribute to persistent disparities in health outcomes for minorities in the U.S. In Study 1, researchers sought to categorize the major factors contributing to the disparity by surveying 2,000 African American and 3,000 Hispanic residents in a major metropolitan city. Of those surveyed, 64% met federal guidelines for living at or below the poverty threshold even though 90% of those surveyed were employed. When asked, "What prevents you from going to the doctor?" the most common responses were financial considerations (92%) , inability to get time off from work for appointments (85%) , lack of transportation (52%) , difficulty communicating with the health care provider (51%) , and fear/distrust of the health care system (48%) .Interpersonally, patients tend to fare better when their physician is of their same racial or ethnic background. Study 2 observed all Hispanic patients (n = 110) who visited a clinic in an urban lower-income community over one week. Patients met with either a Hispanic physician (n = 43) or a white, non-Hispanic physician (n = 67) . The Hispanic physician saw the patients who visited the clinic on Monday or Tuesday, and the white, non-Hispanic physician saw the patients who visited the clinic on Wednesday, Thursday, or Friday. Both physicians were men who spoke Spanish fluently, had been working at the clinic for 8-10 years, and were unaware of the study's purpose beforehand. This study collected data on the duration of the face-to-face appointment time with the physician, medication adherence one month after the appointment, and the number of symptoms disclosed to the physician by the patient. Ninety-eight of the patients were already on medication or were prescribed new medication at the time of their appointment, and patients were contacted one month later for assessment of adherence. The results of this study are shown in Figure 1.

Figure 1 Average appointment time (minutes) , medication adherence (percent) , and number of symptoms disclosed according to patient-physician ethnic discordance vs. concordance
Adapted from W. Yost, (C) 2007 Academic Press.
-Which of the following concepts LEAST helps to explain the results of Study 1?

Quizplus · Accepted Answer

11ecba2d_0c10_931b_a3bf_65b622a906b0_MD0008_00 The goal of Study 1 was to determine factors underlying health care disparities in African American and Hispanic populations, which included financial considerations, work requirements, lack of transportation, and issues with the physician and/or health care system (eg, difficulty communicating, fear, distrust). Many factors contribute to health care disparities, including relative poverty (ie, not having enough money or resources compared to others), accessibility issues (eg, difficulty communicating, lack of transportation), and institutional discrimination (ie, unjust treatment of a social group). Therefore, accessibility disparities, institutional discrimination, and relative poverty are all concepts that do help explain the results of Study 1. Meritocracy, a system in which individual status is based entirely on hard work and ability, least helps to explain the results of Study 1. The U.S. is a class system (not a meritocracy), where an individual's status is partly earned through effort/ability and partly determined by the social class into which one is born. (Choice A) Financial limitations, inability to get time off work, lack of transportation, and difficulty communicating with health care providers are examples of accessibility disparities. (Choice B) Communication barriers and fear/distrust of the health care system may be attributed to institutional discrimination: the unfair or unjust treatment of a social group by an institution (eg, the health care system) or by society as a whole. The social groups most often receiving discriminatory treatment include racial and ethnic minorities and lower-income groups. (Choice D) Individuals meeting criteria for relative poverty do not have enough money or resources compared to other members of a society and are unable to meet the standards of living, including routine medical care. Educational objective: Many factors contribute to health care disparities, including relative poverty, accessibility issues (eg, difficulty communicating, lack of transportation), and institutional discrimination (unjust treatment of a social group).

Passage Both Institutional and Interpersonal Factors Contribute to Persistent Disparities in in Health