Thursday, August 05, 2004

On Health Care Access for Black Americans

A new study finds that black patients tend to see physicians who are less qualified and have fewer contacts for high-quality tertiary care institutions:

''When black patients go to the doctor, they're more likely to be treated by a doctor who can't harness the full capabilities of the health care system," said Dr. Peter B. Bach, an epidemiologist at Memorial Sloan-Kettering Cancer Center in New York who was the lead author of the study in the New England Journal of Medicine.
Examining patterns of office visits by black and white patients on Medicare, the government health insurance program for the elderly, the study found that most blacks were treated by a subset of doctors who had less training than doctors who treated whites, and who told interviewers that they were frequently unable to provide high-quality care.
These doctors, of all races, were less likely than doctors who mostly treated white patients to have passed exams showing mastery of a primary care specialty. They were more likely to report that they could not always help their patients get treatment from specialists, diagnostic imaging such as MRIs, or admission to the hospital when it wasn't an emergency. These differences remained even after the researchers took into account patients' insurance status.

The researchers also found out that similar problems beset other physicians in the same geographical areas. In other words, the access to good quality care is reduced for blacks because of racial segregation in housing: blacks tend to live in areas with lower incomes and with fewer highly-qualified physicians. It's easy to see why lower income areas would not attract large numbers of skilled practitioners; the money just isn't there. But this is something that could be changed by government policies.

Access to health care has shown a racial difference for a long time. This is partly why black health indicators are consistently lower, too, with higher death rates from cancer and heart disease and a much lower average life expectancy. But equalizing all access measures would not equalize the health outcomes: This would require us to do something about the greater deaths from violence among blacks as well as about the lower average incomes of blacks.