A landmark Supreme Court ruling, the Civil Rights Act, and Medicare legislation in the early 1960s led to the coerced integration of American hospitals in cities with substantial minority populations.2 After 1965, hospitals had to accept both Medicare and nonpaying minority patients. As a result, hospitals in geographic areas with substantial low-income minority populations became increasingly financially disadvantaged in subsequent years. Many hospitals eventually left inner-city areas because high numbers of uninsured and underinsured patients made these hospitals economically unviable. Similarly, primary care providers and clinics have fled low-income inner-city areas for suburban areas with better payer mix and fewer minority patients. Hospitals and clinics have found that geography determines profitability. As a result, in many communities, hospital segregation has recurred along socioeconomic lines. This important study by Hasnain-Wynia et al3 in this issue of the Archives raises the simple question: Do minority patients sometimes receive lower quality hospital care because of differential treatment by individual providers or because the hospitals that serve minority patients are less capable?
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 6
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Health care disparities
All results at
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.