Race and Health Care: Dimensions of Inequity by Niko Karvounis

Yesterday I talked a little about segregation of patients by race in NYC hospitals, and noted how this is likely a problem repeated across the nation. Wonder no more: a 2006 study in the Journal of the American Medical Association (JAMA) analyzed about 719,000 Californians who had received a wide range of complex surgeries. The authors found that blacks, Latinos, and Asians were far less likely to get these operations done at high-volume hospitals, which tend to have better outcomes for complex surgeries. (After all, practice makes perfect).

If you’re white, you’re more likely to receive care at high-volume, better-performing hospitals. This is bad in and of itself; but unfortunately, discrimination continues beyond the level of medical institutions and into the level of individual doctors. A 2004 study in the New England Journal of Medicine looked at the primary care experience of Medicare patients, specifically looking at 150, 391 visits by black and white Medicare beneficiaries for “medical evaluation and management who were seen by 4355 primary care physicians.” Here is what they found:

“Most black patients were confined to a small group of physicians (80 percent of visits were accounted for by 22 percent of physicians) who provided only a small percentage of care to white patients. In a comparison of visits by white patients and black patients, we found that the physicians whom the black patients visited were less likely to be board certified (77.4 percent) than were the physicians visited by the white patients (86.1 percent) and also more likely to report that they were unable to provide high-quality care to all their patients (27.8 percent vs.19.3 percent).

The physicians treating black patients also reported facing greater difficulties in obtaining access for their patients to high-quality subspecialists, high-quality diagnostic imaging, and nonemergency admission to the hospital.”

The differential access and care that these studies and others identify might be called discrimination across health care, i.e. segregating the pool of patients by race. But even when blacks and whites find themselves under the same health plan, blacks receive inferior treatment.

Another 2006 JAMA study looked at over 400,000 individuals in 151 Medicare health plants between 2002 and 2004 to judge four outcome measures: (1) control of glucose and (2) low-density lipoprotein cholesterol (LDL-C) among those with diabetes, (3) blood pressure control among those hypertension, and (4) LDL-C control among those who had a acute myocardial infarction or coronary revascularization procedures.

The study found that clinical performance on these four outcome measures was “6.8% to 14.4% lower for black enrollees than for white enrollees” and that “for each measure, more than 70% of this disparity was due to different outcomes for black and white individuals enrolled in the same health plan rather than selection of black enrollees into lower-performing plans.” In other words, black enrollees were getting worse coverage than white enrollees who shared the same health plan.

As the authors note, this gets us thinking about the discrimination within care: “our findings…contrast with other recent studies showing that between-hospital differences are the primary contributor to racial disparities observed nationally in treatments and outcomes…”

Ultimately the racial inequities of American health care pervade the system, across hospitals and doctors and even within health plans. These inequities chip away at the health of our nation, but receive relatively little institutional focus. Instead, we pat ourselves on the backs as we synthesize new wonder drugs and build new hospitals equipped with waterfalls. The U.S. health care system consistently chooses flashiness over fairness.

The tragedy of this choice was perhaps best described by Steve H. Woolf, of the Department of Family Practice, Medical College of Virginia, Fairfax, in an abstract for a 2004 article he wrote in the American Journal of Preventive Medicine:

“Society understands that racial and ethnic minorities experience inferior medical care and health status, but may not appreciate the seriousness of the problem.

“Each year the nation spends billions of dollars to perfect the ‘technology of health care (e.g., development of new drugs) and modernize delivery systems, thereby saving thousands of lives. Correcting disparities in care, however, would avert five times as many deaths.

“If policymakers adhered to the goal of optimizing population health, greater priority would go to resolving disparities than to refining technology, but reverse priorities prevail…Society has the resources to enable the disadvantaged to attain better health but pursues other priorities.”

Comments

[Health Education]

A holistic therapy provides a complementary alternative healing method to standard medicine. Holistic natural health education and health care includes alternative natural health remedies, like herbal healing, and an abundance of health and wellness products and services. http://natural-health-care-information.blogspot.com

[Health Education]

A holistic therapy provides a complementary alternative healing method to standard medicine. Holistic natural health education and health care includes alternative natural health remedies, like herbal healing, and an abundance of health and wellness products and services. http://natural-health-care-information.blogspot.com

[e-Medigap]

It baffles me as to why a society such as ours with such technology and aspirations to find a cure for the most debilitating diseases that plague our planet has the infant mortality rates of a third world country. We really need to re-examine our priorities.

[Texas Medicare Supplements]

Very intersting facts and I must say that they truly amaze me. I would not have guessed anything like this was going on this day and age. I'm not sure if I'm just that nieve or if these facts are truly facts?

[Barry Carol]

Regarding the JAMA study that looked at 400,000 Medicare patients between 2002-2004 focusing on blood glucose, BP and LDL control, I wonder to what extent the racial disparities related to differences in compliance which may, in turn, relate to differences in socioeconomic status and the ability to afford the medications which, at the time, Medicare did not cover.