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

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.