Study finds wide racial, geographic health care disparities among Medicare beneficiaries

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Jun 8 2008

Race and place of residence can have a significant effect on the quality of care a Medicare beneficiary receives, according to a report released Thursday by the Robert Wood Johnson Foundation, the New York Times reports.

The study -- conducted by the Dartmouth University Institute for Health Policy and Clinical Practice's Atlas of Health Care project and led by Dartmouth professor Elliott Fisher -- examined Medicare claims over the past two decades for evidence of racial and geographic disparities in several indicators of health care quality. Blacks were found to be less likely than whites to receive recommended care within a given region, but greater disparities in care were found among different geographic regions, according to the study (Sack, New York Times, 6/5).

The study found:

Sixty-four percent of white women ages 65 to 69 received recommended breast cancer screenings in 2004 and 2005, compared with 57% of black women, while screening rates by state ranged from 74% in Maine to 56.9% in Mississippi (Wilde Mathews, Wall Street Journal, 6/5);
In all but two states, blacks with diabetes were less likely than whites to receive annual hemoglobin testing, and in Colorado, 66% of blacks were screened, compared with 88% of blacks in Massachusetts (New York Times, 6/5); and
Blacks nationwide had their legs amputated at about four times the rate of whites. Black residents of Louisiana, Mississippi and South Carolina had six amputations per 1,000 Medicare beneficiaries, while blacks in Colorado and Nevada had less than two per 1,000 beneficiaries (Appleby, USA Today, 6/5).

Variations in care could be partly attributed to regional differences in education and poverty levels, but researchers "increasingly believe" that variations in medical practice and spending also affect care, the Times reports (New York Times, 6/5). Fisher said, "The level of understanding, and the level of knowledge, varies across communities," adding, "Concern or fear about the tests, health literacy, certainly varies across educational groups" (Wall Street Journal, 6/5).

Initiative

RWJF on Thursday also announced a $300 million program that will aim to reduce racial and regional disparities in health care delivery by targeting 14 communities and regions across the U.S. RWJF President and CEO Risa Lavizzo-Mourey said the funding will allow communities to bring together physicians, employers, patients and others to determine which chronic diseases should be the focus of efforts. The program aims to eventually provide models for national health reform.

RWJF will provide resources and technical expertise to help physicians learn about changes they can make to improve care and to help patients better manage their conditions, Lavizzo-Mourey said. "Despite having the most expensive health care system in the world, patients are subject to too many mistakes, too much miscommunication and too much inequity," Lavizzo-Mourey said (Freking, AP/Chicago Tribune, 6/4). She added, "The only way you can improve quality of care is where it's delivered" (Wall Street Journal, 6/5).

John Lumpkin, senior vice president of RWJF, said, "We want to build a template in each of these communities that will teach America how to improve health care quality in a dramatic way" (New York Times, 6/5). Officials said Aligning Force for Quality is the largest effort of its kind by a private foundation (Boulton, Milwaukee Journal Sentinel, 6/4). The regions that will receive the grants are Cincinnati; Cleveland; Detroit; Humboldt County, Calif.; Kansas City, Mo.; Maine; Memphis; Minnesota; Seattle; south central Pennsylvania; western Michigan; western New York state; Willamette Valley in Oregon; and Wisconsin (New York Times, 6/5).

More information about the initiative and the study is available online.

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.