148989 Civil Rights Enforcement and Health Planning: A Brief History of the Missing LInk

Monday, November 5, 2007: 12:50 PM

David Barton Smith , Department of Risk, Insurance and Healthcare Management, Temple University, Philadelphia, PA
How health services are planned in the United States has had a greater impact on disparities in treatment of disadvantaged minority groups than the overt discriminatory acts of providers. Yet, efforts to apply civil rights laws to health planning have generally been ineffective. The Hill-Burton Act of 1946, while requiring equal access to hospital care, explicitly permitted the use of federal funds to construct racially exclusionary hospitals. The judicial rejection of this “separate but equal” provision was applied to all recipients of federal funding in Title VI of the 1964 Civil Rights Act and first effectively enforced in the implementation of the Medicare program in 1966. While enforcement of Title VI in Certificate of Need programs would have been a logical extension, the federal planning program and local Health Systems Agencies rejected this expansion of their responsibilities. Lacking data and financial leverage, health care civil rights litigation was limited to largely unsuccessful efforts to block hospital relocations. Federal support of regional planning ended in the 1980s and most states chose to either terminate regional planning or greatly reduce its scope. The resulting greater reliance on the financial incentives of the healthcare market has tended to increase the segregation of care and exacerbate its disparities. Forming a viable linkage between civil rights enforcement and health planning requires the will to effectively link the dollars for new health care programs and capital projects to the reduction of racial and ethnic disparities in care.

Learning Objectives:
1. Describe thh role that Totle VI played using the leverage of federal Medicare and Medicaid dollars in eliminating racial discrmination in health care facilities in the 1960's. 2. Assess the effect of the lost opportunity to use that same leverage in the federal health planning and Certificate of Need Program in the 12970's and 1980's. 3. List the key conditons necessary to establish a viable link between civil rights enforcement and health planning.

Keywords: Health Disparities, Social Justice

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.