During the past few years, rationing has become an explicit feature in decisions concerning optimal delivery of health care services, and it poses difficult choices for health care providers and policymakers. Insurers and patients increasingly must balance the desire for access to every possible treatment against concerns about affordability. Costdriven treatment decisions are becoming an unavoidable reality for most patients. Apparently, however, another more pernicious type of rationing occurs in this country. It does not depend on factors such as the likelihood of an optimal outcome, the comparative efficacy of different available treatment modalities, or even the ability to pay for care. Instead, a growing body of evidence suggests that the race of a patient may adversely affect the quantum and quality of health care provided to minority patients. Although no one has identified overt racism by providers, such inequities in the delivery of health care services pose serious problems. This essay describes racial disparities in three separate health care contexts: the utilization of Medicare services, the selection of recipients for cadaveric organ transplantation, and the representation of racial and ethnic minority groups in clinical research. The essay then suggests ways in which medical educators, health care providers, and government agencies can work to address these disparities in care, and it explores possible constitutional and statutory remedies for the victims of disparate treatment. Ultimately, the medical establishment must face up to the possibility that African-American patients do not receive equal treatment in the health care system.
48 Fla. L. Rev. 357 (1996)