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Editorial Columns How Does Race Matter Anyway In two articles published since 2001 Balsa and McGuire 2001 2003 have used the language and tools of economic theory to examine several phenomena that can influence doctors decision making during clinical encounters that patients and result in racial disparities in health care These articles which adapted and extended earlier theoretical developments in labor economics were published in an economics journal and are unlikely to have been read by many health services researchers Therefore a brief summary of the articles is in order Balsa and McGuire 2003 identified prejudice clinical uncertainty and stereotyping as distinct mechanisms that can operate within the clinical encounter and lead to racial disparities in care Drawing on the literature in social psychology they defined prejudice as the holding of a negative attitude or affect against members of another racial group e g white physicians may be prejudiced against black patients By modeling prejudice as a psychological cost experienced by white physicians when they treat black patients Balsa and McGuire showed that prejudiced white physicians would provide less care to blacks than to whites Balsa and McGuire 2003 also considered the effects of two types of clinical uncertainty In the first type physicians were assumed to have only noisy indicators of patients clinical condition perhaps as a result of imperfect diagnostic tests so they were necessarily uncertain about patients precise diagnosis or severity The investigators found that under such circumstances physicians would be forced to rely on prior probabilities e g the prevalence of disease in making diagnostic and treatment decisions Thus for instance if the prevalence of disease were lower in blacks than in whites even unprejudiced physicians would be less likely to recommend treatment to black patients than to white patients As a result more black patients than white patients who would benefit from treatment



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