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

    Racial Disparity Despite Quality Care

    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."

    Why is racial disparity in health care so hard to get rid of?

    "At the core here, we have a problem in the culture -- in the culture of medicine, in the culture of the country, and in the culture of African-Americans and their behavior," LaVeist tells WebMD. "It is much bigger than just health care alone.

    "Health disparities track with disparities in education, in wealth, and in incarceration," he says. "All these disparities track each other. It is not something those in the health industry alone can fix; it is a broader experience."

    Ayanian says a lot could be learned from high-quality health plans that have eliminated racial disparity in health outcomes. But there's a problem here. Of the 151 plans studied, only a single plan had the same racial outcomes on more than one measure -- and that plan eliminated disparity on only two of the outcomes.

    Other studies, Ayanian says, offer hints about how health plans can lessen disparities and improve outcomes for all patients.

    "It is important for plans to have accurate and up-to-date information on whether patients are achieving good control; to provide reminders both to doctors and patients when they don't have good control," Ayanian says. It is also important, he continues, to "potentially have nutritionists or health navigators work with patients to understand barriers to good control."

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