Institute report: minorities get poorer health care. (On First Reading).

Minorities receive poorer health care than white Americans and are less likely to get routine medical procedures--even when insurance, income and age are comparable, according to the Institute of Medicine (IOM) March study, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care."

Worse yet, differences in quality of care result in poorer health, including higher death rates among minorities, the report says.

An institute committee found that racial disparities in health care are "remarkably consistent across a range of illnesses and ... services."

Consider this: Racial and ethnic minorities are less likely to receive tests, treatments and medications for cardiac problems, cancer and HIV.

At the heart of the problem, the report says, are patient and provider attitudes and so-called "system-level factors"--language and geographic barriers, cost-containment pressures and the like. A clinic visit--brief as it may be--can be the start of the unequal treatment.

The main problem is "a failure to communicate--partly because of the hurried nature and pressures of time," says Dr. Alan Nelson, the institute committee chairman. "A relationship of trust can't build," he says. The result is greater clinical uncertainty that may encourage the provider to fall back on stereotypes.

Confronting the problem is difficult. Among the IOM's recommendations: Increase awareness of disparities among the general public, policymakers and health care providers.

Also on the list: Strengthen the stability of patient-provider relationships in publicly funded health plans and increase the diversity of health care providers since racial and ethnic minority providers are more likely to serve in minority and medically underserved communities.

Nelson says there needs to be "greater awareness among the professions" about how stereotypes influence their behavior. Michigan Senator John Schwarz, a medical doctor, agrees that raising awareness is a necessary first step and also argues for eliminating language barriers.

The problem, according to Schwarz, also lies in too few places where African Americans and others can connect with quality health care, particularly in inner cities like Detroit. Schwarz sees "too many people who are on the outside looking in." To remedy this, he suggests that legislators and others work together to "bring the system to people as effectively as possible."