Black Patients Enrolled in Medicare+Choice Receive Lower Quality of Care Than White Patients, Study Finds
Black patients enrolled in Medicare+Choice plans receive poorer quality of care than white patients across several measures, according to a study appearing in today's Journal of the American Medical Association. The Newark Star-Ledger reports that the study by researchers Harvard University's public health and medical schools found that blacks fared worse than whites in obtaining four medical services "considered crucial to quality care": follow-up exams after hospitalizations for mental illness, eye exams for diabetics, the use of beta-blockers after heart attacks and breast cancer screenings for women. The study, the latest to examine racial disparities in the U.S. health care system, goes a step farther than previous research in exploring the discrepancies, showing that these difference not only affect access to care but also quality of care. Led by Harvard's Eric Schneider, researchers examined information from the Health Plan Employer Data and Information Set (HEDIS), to which Medicare+Choice plans are required to submit quality of care data every year. The study examined 305,574 beneficiaries who were enrolled in a Medicare managed care plan in 1997 -- nearly 8% of all Medicare beneficiaries at the time -- and had at least one of the four types of treatments that year (Goldsmith, Newark Star-Ledger, 3/13). For all the treatments except breast cancer screening, the study found that the racial disparities persisted even after researchers accounted for factors generally associated with poorer medical care, including income and education. The findings include:
- In the largest discrepancy, 33.2% of blacks received follow-up care after being hospitalized for a mental illness, compared to 54% of whites (Pelton, Baltimore Sun, 3/13). Schneider said that it was likely that, based on this finding, blacks were more likely to suffer relapses and readmission to hospitals for mental illness (Tanner, AP/Philadelphia Inquirer, 3/13).
- 43.6% of blacks with diabetes received eye exams, compared to 50.4% of whites. Diabetes, which affects blacks disproportionately, can lead to glaucoma and subsequent blindness.
- 64.1% of blacks received beta blockers after heart attacks, compared to 73.8% of whites. The drugs help to prevent repeat attacks.
- 62.9% of black women received breast cancer screenings, compared to 70.9% of white women (Baltimore Sun, 3/13). Schneider, however, said this discrepancy could be explained by factors other than race, such as enrollment in health plans that do not stress screening (Ricks, Newsday, 3/13).
According to the Baltimore Sun, the study is considered significant because it compares people of different races with similar managed care policies (Baltimore Sun, 3/13). Based on previous research showing that black Medicare+Choice patients had better access to care than blacks with traditional Medicare coverage, the researchers had predicted that black and white Medicare managed care members would receive equal care (Newsday, 3/13). Instead, the findings suggest that there is more to racial health disparities than a higher rate of uninsurance and lower income among blacks, two factors that many have traditionally viewed as contributing to the "inferior health care and shorter life expectancies" of many blacks (Baltimore Sun, 3/13). Schneider said that possible reasons for the discrepancies include racial bias among doctors and cultural differences, "including a tendency among some blacks to shun some preventive health care measures" (AP/Philadelphia Inquirer, 3/13). Kweisi Mfume, president of the National Association for the Advancement of Colored People, said, "To tackle the problem, we need to have real public education take place so that people understand themselves and their health conditions in a better way."
The study is also considered significant because of its large sample size and use of quality of care measures (Baltimore Sun, 3/13). "This is one of the first chances we've had to have some really hard data on quality of care," Karen Scott Collins, vice president of the Commonwealth Fund, said (Newark Star-Ledger, 3/13). The group released its own study last week finding minorities receive lower-quality health care than whites, based on telephone interviews with patients (California Healthline, 3/7). While the Harvard study only applied to Medicare+Choice beneficiaries, Collins said that the findings could likely apply to all populations. However, she said that managed care was not to blame for the disparities, saying MCOs are "ahead of the curve" in attempting to end discrepancies (Newark Star-Ledger, 3/13). The study's authors urged CMS to expand the collection of HEDIS data to other types of government insurance programs as a way to better understand racial disparities (Schneider et al., JAMA, 3/13). Schneider added that he hoped the report would encourage health plans to monitor themselves using the HEDIS data and look for ways to reduce disparities. "I know that it is controversial, but we feel that data we found could motivate health plans to be more direct and proactive in analyzing data this way," he said (Newark Star-Ledger, 3/13). The study is available at online.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.