This project ties together the history of racial segregation and discrimination in health care and efforts to end it through litigation and regulation. A history of racial segregation in health care and insights into the impacts of discrimination on discrepancies in access and outcomes is presented. Dr. Smith provides two illustrative case studies. One describes the patterns of use of maternity services in a metropolitan area. Another describes the problems in assuring nursing home compliance with the Civil Rights Act. Dr. Smith assesses current organizational, methodological and data gaps associated with enforcing compliance with Title VI of the Civil Rights Act through the courts and regulatory agencies. He also addresses possible approaches, through regulatory and health care reform, for responding to continuing discrepancies and segregation in more subtle forms. Results focus on the need for policy interventions to monitor bias and ensure that changes in the delivery system do not institutionalize patterns of discrimination.

David Barton Smith received his doctoral degree in medical care organization at the University of Michigan in and is currently a professor in the department of risk, insurance, and healthcare management at Temple University. He is the author of numerous articles and five books on the organization of health services including, Health Care Divided: Race and Healing a Nation (The University of Michigan Press, 1999) and Reinventing Care: Assisted Living in New York City (Vanderbilt University Press, 2003). He received a 1995 RWJF Investigator Award for research on the history and legacy of the racial segregation of health care and continues to write and do research on this topic.