US civil rights policy and access to health care by minority Americans: Implications for a changing health care system

The history of health care discrimination as well as ongoing, extensive evi dence of racial disparities argue for continued vigilance in the area of he alth care and civil rights. Under Title VI of the Civil Rights Act of 1964, individuals have challenged de facto discriminatory policies adopted by he alth entities receiving federal financial assistance. Title VI health litig ation is difficult because of complex issues of proof as well as confoundin g problems of poverty and lack of health insurance that affect both claims and remedies. An analysis of cases brought under the law suggests that disc rimination claims within a particular market fare better than those challen ging decisions to relocate or alter the market served. This has important i mplications for claims involving discrimination by managed care organizatio ns. Because the same potential for discrimination exists in the new health system of managed care, although in altered form, data collection and evalu ation are warranted.