Tulane Study Finds Discrimination in Healthcare Scheduling

Researchers have found discrimination and bias may force some patients to wait longer than others for healthcare appointments.

A Tulane survey discovered people of ethnic minorities may have to wait up to seven days longer than white callers to schedule an appointment at a medical facility.

The survey of primary care appointment wait times also found minority callers may face more questions before being able to set up an appointment to see a medical professional.

Tulane research assistant professor Brig Walker said black and Hispanic callers were sometimes asked up to double the number of questions about their insurance than white callers.

The Tulane team recruited seven female callers who identified themselves as non-Hispanic black, non-Hispanic white, or Hispanic. The women then invented a pseudonym they felt represented their gender, racial and ethnic identities and placed recruitment requests with more 800 primary care officers in the state.

The appointments were made across 2 urban centers from November 2017 to February 2018, with data collected between February and December of 2018. Researchers randomly assigned offices to make appointments, supplying the same basic information each time.

Tulane found black callers were 44% more likely to be asked about their insurance than white callers; Hispanic callers were 25% more likely to be faced with inquiries.

Lead author of the study Janna Wisniewski said: “Schedulers may have believed that race and ethnicity were associated with insurance status, and those who asked about insurance appeared to be inquiring in response to race and ethnicity signals.

“Asking about insurance may imply scheduling staff’s concern about the caller’s ability to pay.”

On average Hispanics faced a wait three days longer than that of white callers, while black callers faced an extra-long delay of seven days.

The study also opens up questions surrounding women’s healthcare in the US.

Walker said: “There is significant literature on the effects whether it be mental health, the stress, as well as the physical distress and challenges that are coming from delays.”

He added that findings from the research could help reduce discrimination in the healthcare industry, and may trigger a switch to appointment scheduling automation which would ensure complete equality within the system.

“It’s not saying that this is not necessarily out of malice, it’s just something that is implicit and beneath the surface, but leading to actual tangible differences in care access,” said Walker.

As for the results of the research, Wisniewski noted the dangers of forcing patients to wait for medical appointments, in the same way some low-income families may face a wait for vaccines.

She said: “Timeliness of care is really important. Delay in seeing a provider means that the patient spends more time experiencing the illness or injury. They may be anxious or in pain for longer. They may struggle for longer to go to work or take care of their family.

“Delay also gives the condition more time to worsen, which means that if a health system gives more timely care to one group over another, the health system itself may be contributing to health disparities.”

Wisniewski suggested offices should offer further staff training in the hopes of opening further conversations surrounding bias in healthcare settings. It is thought hosting discussions on healthcare discrimination could help staff to think more openly when handling calls.

She said: “This is not something that’s routinely checked in hospitals and clinics, whether they’re inadvertently discriminating based on race or ethnicity. Starting to even look at that and bring attention to it might be a good first step.”

The study has been published in JAMA Network Open for viewing.