Race Affects Health Care

Racial disparities in health care exist even in high-quality health care plans, says a study by researchers at Harvard and Brown medical schools published Wednesday in the Journal of the American Medical Association.

The findings are significant because they reveal more than just an overall racial discrepancy—which has been well documented—but also discrepancies within the same health care plans.

“Other studies have focused on whether white and African-American patients are equally likely to receive simple blood tests,” said co-author John Z. Ayanian, associate professor of medicine and health care policy at Harvard Medical School. “In our study, we focus on the outcomes of care,”

Researchers tracked 334,204 patients within over 100 different Medicare-managed care plans, said Amal N. Trivedi, another co-author of the study and an assistant professor of community health at Brown Medical School.

“We looked at how well each plan in Medicare performs in controlling blood sugar, cholesterol, and blood pressure for their enrollees,” Trivedi said. Specifically, the outcomes of patients with diabetes, hypertension, and a recent heart attack or heart surgery were analyzed.

The findings demonstrated that racial inequalities in health care are not largely caused by the enrollment of more blacks in lower-quality health plans, as had previously been suggested. Instead, the study found some health care plans with racial discrepancies in outcome of more than 20 percent within the same plan.

The study also found that only one health plan of all the plans that were tracked had both high performance and low disparity.

The conclusions reached in the study can help plans develop programs to improve equality in treatment, said Trivedi.

“[The study] provides specific information that can help [health care plans] design programs to eliminate disparities,” he said.

Ayanian said that the Medicare program should work closely with health plans to monitor the quality of care for different racial and ethnic groups.

Most health plans don’t currently even collect information on health and ethnicity, said Trivedi. But he said collecting the data is important because health care plans “can’t improve what they don’t measure.”

“We know that we can prevent strokes, heart attacks, and premature death if we improve quality and reduce disparities,” said Trivedi. “We can save lives.”