Contra Costa County resident Kam Shaw is just one example of a Black Californian who feels shortchanged by our health care system.
In July, Shaw, whose name has been changed to protect her medical privacy, tried to get an urgent appointment for 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 secure a same-day appointment. She didn’t hear back until 4 p.m., by which time she was in extreme pain and barely able to walk.
Shaw was forced to take an expensive trip to the emergency room but didn’t receive a diagnosis. Instead, she was sent home with medication and a bandage wrap with instructions to contact her primary provider in 5 to 7 days if she was still in pain. Shaw never received any additional follow up or information from the hospital or her provider about her foot injury. Ultimately, Shaw’s foot ended up recovering on its own, but she was left feeling like no one cared about helping her, even though she had health insurance coverage.
Black Californians have one of the lowest life expectancies in California and disproportionately face higher COVID-19 mortality rates. This is despite the fact that the vast majority of these residents have some form of insurance coverage and consistently demonstrate a strong 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 lack of respect from providers, discrimination based on type of insurance coverage and missed diagnoses due to being ignored by providers.
The anecdotes from the report serve as poignant examples of how discrimination and bias within the health care system can negatively impact health. One Bay Area resident said he preferred Black doctors because he felt those providers would be more likely to listen to him. Other respondents lamented a shortage of Black mental health professionals and said it impeded their ability to find therapists they could connect with. Some said they just wanted to find a competent and compassionate provider, regardless of race.
Black Californians already face structural barriers to maintaining good health due to the legacy of racism, including disproportionately high rates of poverty and lack of access to healthy food and green space.
Importantly, the report also highlighted positive findings including high levels of health insurance coverage among respondents, considerable interest in maintaining health and interest in building relationships with providers.
Another challenge Shaw has faced is finding a provider she feels comfortable with. During our conversation, she continuously noted how she’s struggled to find a Black, female physician to replace her prior provider who recently retired. Shaw had positive experiences with this physician and felt accepted and heard as a Black woman.
Shaw’s experience highlights a larger issue in California’s health care system, a shortage of Black providers to meet the needs of Black patients. Research shows that patients who receive care from providers with a shared racial identity tend to have better communication and increased quality of care. This provider shortage along with limited accountability for health systems that fail to adequately meet the needs of Black patients are structural factors that can have major consequences for Black patients. They go beyond the problem of bias or racism among individual providers.
“We’ve spun our wheels … trying to make people aware of their own implicit biases and thinking that would help without changing the system around them,” Katherine Haynes, senior program officer at the California Health Care Foundation, told me when referencing the focus on individual provider bias and discrimination in the health care system.
California is working to address this, Haynes said. She pointed to efforts by Covered California and the California Department of Health Care Services to hold health plans accountable if they fail to take action to address inequitable health outcomes among their patients. To accomplish this, state health regulators will need more information about how Black patients are experiencing care. Health care providers can gather this information by routinely asking patients for feedback on the care they receive and efforts made to improve their experiences, Haynes said.
The means to gather this information already exists. The statewide office of Health Care Access and Information, a department charged with strengthening California’s workforce and expanding quality health care access, collects key race and ethnicity data as well as information centered on health care quality and patient access.
A combination of state laws and existing regulations requires the department to collect aggregated information about the quality of care for Black patients. This includes Assembly Bill 1204, signed into law last year, which requires the state to develop and administer a health equity report program, with annual equity data from California hospitals. I encourage policymakers and regulators to closely monitor the data to identify recurring inequities for Black patients and take measures to address any major gaps.
Acting on the data and implementing solutions will be key to progress.
Ultimately, the goal is to gather the data necessary to show how well plans are doing when it comes to addressing the needs of their Black patients. Beyond data collection and development of performance measures, I support efforts to strengthen California’s health workforce pipeline to ensure that one day, Black patients will not have to struggle to search for providers that look like them.
Over the course of my conversations, one thing became clear: Black Californians like Shaw want to build lasting, positive relationships with their health care providers. They want greater respect and partnership. California’s health care system needs to answer that call.
Denzel Tongue writes a column for the California Health Report about the intersection of racial justice, public policy and health equity. 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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