Racial and ethnic health disparities and the unfinished civil rights agenda.

Civil rights-era efforts to end disparities in health care in federally financed health programs faced three successively more difficult challenges: (1) ending Jim Crow practices, (2) eliminating more subtle forms of segregation, and (3) assuring nondiscriminatory treatment in integrated settings. Federal efforts peaked with the implementation of the Medicare program. Visible symbols of Jim Crow disappeared, and most crude disparities in access were eliminated. The unfinished parts of the civil rights-era agenda, the persistence of more subtle forms of segregation, and the failure to assure nondiscriminatory treatment pose major challenges to current efforts to eliminate health care disparities.