Medical Civil Rights: The Exclusion of Physicians of Color from Managed Care - Business or Bias?

Abstract

Physicians of all races and ethnicities have long voiced a litany of complaints against managed care. Much less publicized and more frequently ignored is the very serious complaint expressed by African-American, Asian-American, and Latino/a physicians - managed care organizations effectively discriminate against them. In the end, the direct impact of discriminatory or exclusionary practices is felt by minority patients enrolled in HMOs, PPOs and other managed care arrangements; patient choice in selecting physicians of similar racial/ethnic background is severely restricted, ultimately compromising both the quantity and quality of health care services patients of color receive. This Article analyzes whether managed care organizations are biased against minority physicians in five Parts. Part I discusses the allegations of bias and examines the evidence supporting the claims. Part II analyzes the contracting patterns of managed care organizations and suggests that many of the physician selection and termination criteria unwittingly devalue the efficiency and quality of minority physicians, which often leads to inequitable actions and decisions. Moreover, this Part shows how exclusion from provider networks potentially widens the existing racial health gap. In Part III, the focus is on the history of exclusion within the medical profession. This history is important because it helped shape the organizational structure of minority physician practices, dictated the types of patients they serve, and influenced the location of their practices. The concluding two parts discuss remedies. Because the problem of exclusion is complicated, this Article proposes multiple remedies involving legislative solutions at the local, state and federal levels.