Discrimination in the Health Care System:
What People Experience and What It Costs
Discrimination in health care remains a persistent barrier to equitable treatment, trust, and timely access to care, particularly for older adults, individuals with lower incomes, and people with marginalized identities.
National research shows that a substantial share of adults experience disrespectful or discriminatory treatment in medical settings. These encounters are often repeated and cumulative, with lasting consequences for both health and financial security.
With funding support from the SCAN Foundation, this two-part research initiative from the LeadingAge LTSS Center at UMass Boston examines discrimination in health care from complementary perspectives. The qualitative study elevates patient voices to understand how discrimination is experienced and how it shapes care-seeking behavior. The quantitative analysis uses nationally representative data linked to Medicare claims to assess how reported discrimination is associated with differences in health care use and spending.
Together, these reports demonstrate that discrimination is not only a moral and equity issue – it is a measurable health system performance and cost issue.
Our Approach
Qualitative Study: Lived Experience
The LTSS Center conducted three virtual focus groups with adults ages 52–70 who self-identified as having experienced discrimination in health care. Participants represented diverse racial, ethnic, gender, socioeconomic, and insurance backgrounds.
Focus groups were recorded, professionally transcribed, and analyzed using an inductive thematic approach to identify recurring patterns and policy-relevant insights.
Qualitative Data Sources and Scope
- Three virtual focus groups (N = 21 participants)
- Adults ages 52-70 with recent experiences of health care discrimination
- Thematic analysis of verbatim transcripts using NVivo
- Study approved by the University of Massachusetts Boston IRB
Quantitative Study: Utilization and Spending
The quantitative analysis uses data from the Health and Retirement Study (HRS), a nationally representative longitudinal survey of U.S. adults age 50+, linked to Medicare claims data.
Researchers examined:
- Self-reported experiences of discrimination in health care
- Total Medicare spending
- Inpatient, outpatient, and emergency department spending
- Changes in spending following reported discrimination
Multivariate regression models were used to compare individuals who reported discrimination with those who did not, adjusting for health status, demographic characteristics, and socioeconomic factors.
Quantitative Data Sources and Scope
- Nationally representative adults age 50+
- Linked HRS survey and Medicare claims data
- Analysis of utilization between 2012–2022
- Adjusted models accounting for health and sociodemographic differences
This qualitative work complements the LTSS Center’s broader research on discrimination, health equity, and long-term services and supports.
Key Takeaways
Discrimination is common and increasing.
Nearly 1 in 5 older adults (19%) reported experiencing discrimination in health care in 2020–2022, up from 15.5% in 2012.
Experiences are cumulative and system-shaping.
Participants described repeated encounters of being dismissed, rushed, or not taken seriously—often across multiple providers and settings.
Discrimination erodes trust and continuity of care.
Individuals reporting discrimination were less satisfied, less likely to have a usual source of care, and more likely to feel their preferences were ignored.
Delayed and avoided care leads to higher-cost utilization.
Both qualitative and quantitative findings point to a common pathway: negative experiences → disengagement from care → greater reliance on acute and inpatient services.
Discrimination is associated with higher Medicare spending.
After adjusting for health and demographic factors, individuals reporting discrimination had 31% higher odds of above-average costs in subsequent years.
Costs accumulate over time.
Each reported experience of discrimination was associated with approximately $1,100 in additional Medicare spending, independent of aging and worsening health.
The national fiscal impact is substantial.
Excess Medicare spending attributable to discrimination reached:
- $14.2 billion in 2022
- $73.2 billion cumulatively (2012–2022)
Nearly $89.6 billion when expressed in current dollars
How to Use This Resource
These reports are designed to support action across research, policy, and practice. Readers can use them to inform advocacy, system reform, and public engagement efforts focused on equity and respectful care.
Policy Development
Support reforms that treat discrimination as a measurable quality-of-care and accountability issue.
Health System Improvement
Incorporate findings into training initiatives, patient advocacy models, complaint response systems, and equity performance metrics.
Advocacy and Education
Use participant narratives and spending data to demonstrate how discrimination affects both lived experience and system costs.
Research and Teaching
Apply the analytic framework and findings in academic courses, policy briefings, and future research on aging, equity, and health system accountability.
About the Project Partners
The SCAN Foundation
The SCAN Foundation (TSF) envisions a society where all of us can age well with purpose. We pursue this vision by igniting bold and equitable changes in how older adults age in both home and community. Our grants and impact investments prioritize communities that have been historically marginalized with an emphasis on: older people of color, older adults with lower incomes, and older residents in rural communities.
Learn more at www.thescanfoundation.org.
Contributors
Claire Wickersham
Senior Research Associate at the LeadingAge LTSS Center @UMass Boston
