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Racial Disparity Despite Quality Care

Even in Identical Health Plans, Blacks' Health Outcomes Worse Than Whites'

WebMD Health News

Oct. 24, 2006 - Even when enrolled in identical Medicare health plans, black patients have worse health outcomes than white patients.

The finding comes from researchers at Harvard and Brown universities, who studied data from 431,573 patient visits covered by 151 Medicare managed care plans from 2002 to 2004.

In an earlier study of Americans enrolled in managed care plans, researchers Amal N. Trivedi, MD, MPH; John Z. Ayanian, MD; and colleagues found encouraging data. In managed care plans, they found, the quality of care given to black patients was rapidly becoming as good as the quality of care given to white patients.

Unfortunately, the new findings burst that bubble. Regardless of whether they are enrolled in high-quality or low-quality Medicare managed care plans, black patients don't benefit as much as white patients.

"We found no differences in racial disparity between lower- and higher-quality plans," Ayanian tells WebMD. "It is not simply that African-Americans enroll more often in low-quality plans. We found that over two-thirds of the disparity in outcomes was evident across health plans."

The findings appear in the Oct. 25 issue of The Journal of the American Medical Association.

Poorer Diabetes, Heart-Disease Control for Blacks

Ayanian and colleagues looked at three important things patients should get from health care:

  • People with diabetes should be able to get their high blood sugar under control.
  • People with high blood pressure should be able to lower it.
  • People with high cholesterolshould be able to lower their cholesterol -- especially if they have diabetes or if they've already had a heart attack.

Across 151 health plans studied:

  • Among patients with diabetes, 80.2% of whites and 72.2% of blacks got their blood sugar under control.
  • Among patients with high blood pressure, 60.2% of whites and 53.4% of blacks got their blood pressure under control.
  • Among patients with diabetes, 72.2% of whites and 62.9% of blacks got their cholesterol under control.
  • Among patients who had had previous heart attacks, 71.6% of whites and 57.2% of blacks got their cholesterol under control.

In the best health care plans, more than half of patients improve on all these measures. In the worst plans, fewer than half improve.

The high-quality plans and low-quality plans all enrolled both black and white patients. Racial disparities were just as common in the high-quality plans as in the low-quality ones.

More Than Doctors Alone Can Fix

This is no surprise to Thomas A. LaVeist, PhD, director of the Center for Health Disparities Solutions at Johns Hopkins University's Bloomberg School of Public Health.

"These are people who had insurance, got care, were seen in the system -- and got different outcomes according to race," LaVeist tells WebMD. "So all the excuses we hear -- that it is lack of insurance, that it is patient preference that drives disparity -- are out of the question."

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