Presented in this paper is a theoretical framework for understanding and applying the concept of institutional racism to the medical/health care system. Medicine and health are viewed as vital social institutions that reflect the norms, values and social stratification systems of the larger society. Institutional or systemic patterns of racism are legitimated and promulgated through accepted standards, criteria, and organizational processes within the medical health complex that have the effect of discriminating against the minority group. It is maintained that racism is manifested (overtly or covertly) through history, ideology, community relations, research, education and the professions, and differential treatment. Focusing on investigators who have conducted studies of "racial bias" in the diagnosis and treatment of coronary artery disease, the author discusses some of the shortcomings of this research, from an institution racism perspective. Differential treatment researchers are encouraged to include social theory as part of their analysis and to explain the practical significance of their findings for the equitable delivery of health care. It is suggested that, because of wider structural changes occurring in American society, issues related to racism within medical and health institutions will become increasingly more important.