As have previous researchers, "We found significant differences in quality of care experienced by blacks compared with that of whites," said lead author Beth A. Virnig of the University of Minnesota School of Public Health, writing in the November/December issue of Health Affairs. "We show that these differences are also present for Hispanic and Native Americans, although the magnitudes and patterns may differ."
The study looked at access to and quality of Medicare managed care, expanding previous black-white population analysis to Hispanic, Asian and Native Americans.
The authors studied several million records from 301 Medicare+Choice (managed care) plans, measuring care levels among the ethnic groups for: breast cancer screening, cholesterol control in heart and stroke patients, use of beta-blockers in heart attack survivors, diabetes care, control of high blood pressure, and access to care.
Highlights of the analysis, which the authors said is one of the first reports of its kind:
-- Asians, along with those labeled "others," were as likely or more likely than whites to receive good health care in all areas measured by the study.
-- "Compared with white women, Hispanic women showed even greater disparities in receipt of a mammogram than did black women. This may be the result of different cultural attitudes and beliefs with regard to the effectiveness of mammography, or it may simply reflect the fact that most of the effort to increase breast cancer screening rates for minority women has focused on African Americans."
-- Blacks are the only racial group for which the rates of diabetes care were significantly lower than for whites.
-- Whites are less likely than Hispanics and Native Americans to have their high blood pressure controlled.
-- Native Americans are less likely than other ethnic groups to have a mammogram or to have their LDL cholesterol checked as part of diabetes care.
Among the statistical limitations, the authors report, is the fact that all racial groups are heterogeneous. For example, while Asians as a group may receive good health care, it is possible that the same may not be said for some subgroups, such as Vietnamese or Hmong. Also, the number of non-black ethnic groups included in the analysis was small.
"Despite these limitations," the authors conclude, "these data highlight the need to examine disparities among multiple racial/ethnic groups. While continued documentation of disparities does little to advance our understanding of what to do about them, continued measurement of disparities in quality will be important in designing and evaluation interventions to address them."
The study was supported by a contract from the Centers for Medicare and Medicaid Services.
FOR MORE INFORMATION
Health Behavior News Service: (202) 387-2829 or www.hbns.org.
Health Affairs: For copies of the article, contact Jon Gardner at (301) 656-7401, ext. 230 or
jgardner@projecthope.org.
Journal
Health Affairs