"What we're seeing is that racial and ethnic discrimination in the U.S. health care system is not uncommon — in fact, it is dramatically more common than in other high-income countries," said study coauthor and Commonwealth Fund vice president for advancing health equity Laurie Zephyrin, M.D. "Biases against older people of color are experienced throughout the health care system, and they need to be intentionally rooted out. Health care organizations must be accountable for treating all patients equitably. Policies and practices can help ensure this accountability."

Across 11 high-income countries, U.S. older adults were the most likely to report that the health system treats people differently because of their race or ethnicity. Thirty-two percent of U.S. older adults made this statement, nearly twice the percentage of older adults in Canada, the country with the next-highest rate. U.S. Black women and men are the most likely of any group to believe the health care system discriminates based on race and ethnicity.

Nearly half of U.S. older adults who experienced racial or ethnic discrimination said they were in fair or poor health, which is twice the rate of those who did not experience discrimination. In fact, three-quarters of adults who believe they have been discriminated against have three or more chronic conditions or need help with daily activities. They also are far more likely than other older adults to feel socially isolated, have a mental health diagnosis or undergo financial hardship.

The authors made several policy recommendations:

Promote transparency and accountability by calling out discrimination and publicly reporting discrimination data. Providing patients with the opportunity to report experiences with discrimination in standard satisfaction surveys is one way to do this.

Educate medical professionals on the history of racism in health care and train them in how to address their own implicit biases. Health care professionals must learn to recognize and discard stereotypes that can affect treatment decisions.

Diversify the U.S. health care workforce. For example, medical schools should be accountable for improving diversity among faculty and students. One way to diversify is by focusing recruitment efforts on historically Black colleges and universities and Hispanic-serving institutions.

"The consequences of health care discrimination against older adults of color are serious," Michelle M. Doty, lead study author and vice president for organizational effectiveness, survey research and evaluation. "People are not getting the care they need, their concerns are being ignored, and their health is suffering as a result. As a society, we can work to end discrimination in the health system, first by recognizing discrimination and then actively working to dismantle it."

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