1990; Anderson et al., 1986; Trevino et al., 1991). Dental services are not covered well by most insurance policies, and minority access to dental care is especially problematic. Although the use of dental services has increased over time for all racial groups, the absolute percentages of persons who see a dentist in a given year is still unacceptably low. In 1993, for example, among persons 25 years of age and over, only 64 percent of Whites, 47 percent of Blacks, and 46 percent of Hispanics had visited a dentist within the previous year (National Center for Health Statistics, 1998).

Research also reveals there are large and systematic racial differences in the quality of medical care provided, which reflects, at least in part, the role of racism. Louis Sullivan, the former Secretary of Health and Human Services, concluded that “There is clear, demonstrable, undeniable evidence of discrimination and racism in our health-care system” (Sullivan, 1991). Evidence of discrimination comes from studies that have examined Black-White differences in access to a broad range of specific medical procedures. These studies reveal that, even after adjustment for health insurance and clinical status, Whites are more likely than Blacks to receive coronary angiography, bypass surgery, angioplasty, chemodialysis, total-knee arthroplasty for osteoarthritis, intensive care for pneumonia, and kidney transplants (Giles et al., 1995; Council on Ethical and Judicial Affairs, 1990; Wilson et al., 1994). Blacks are less likely than Whites to be on the waiting list for kidney transplants and once on the list, are likely to wait twice as long to receive a kidney (Sullivan, 1991).

A recent analysis of 1.7 million inpatient discharge abstracts from a national sample of 500 hospitals revealed that for almost half (48 percent) of a broad range of disease conditions, Blacks were less likely than Whites to receive major therapeutic procedures (Harris et al., 1997). Studies of specific health conditions also document racial differences in the intensity of medical care for comparable conditions. A cohort study of 8,406 Black and White men with prostate cancer found that, with comparable disease, Black men were 2.2 times less likely than their White peers to receive aggressive therapy (Schapira et al., 1995). Similarly, a national study using randomly selected hospitals found that among patients with pneumonia, non-Whites (mainly Blacks) compared to Whites, received fewer hospital services than expected on the basis of their health status and had longer than expected hospital lengths of stay (Yergan et al., 1987). It is important to note that these racial differences were apparent not only in the aggregate, but also within individual hospitals.

Especially striking are racial differences in the Veterans Health Administration (VHA) system and the Medicare program. Among inpatients in these two large federal programs, racial differences should be eliminated by the absence of differences in insurance coverage; yet, racial