[Hpn] Poorer Care for Blacks Found in Medicare Hmos

[Thomas Cagle]

Poorer Care for Blacks Found in Medicare Hmos
Tue Mar 12, 5:22 PM ET

By Amy Norton 

NEW YORK (Reuters Health) - Older African Americans enrolled in Medicare
managed care plans may get a poorer quality of care than whites in the
same
plans, the results of a new study suggest.

The study of more than 300,000 enrollees in Medicare HMOs showed that
African Americans were less likely to receive breast cancer (news - web
sites) screening, diabetes-related eye exams, certain heart drugs and
follow-up care after being hospitalized for mental illness.

The difference in breast cancer screening between blacks and whites
seemed
to be explained by the disproportionate number of African Americans in
poorer-quality health plans, the study's lead author told Reuters Health.

As for the other three measures of healthcare quality, though, the racial
discrepancy was seen within most individual managed care plans, said Dr.
Eric C. Schneider of the Harvard School of Public Health in Boston,
Massachusetts. 

He and his colleagues report their findings in the March 13th issue of
The
Journal of the American Medical Association (news - web sites).

A number of studies have found racial disparities in the quality of
healthcare in the US, including research showing that African Americans
are
less likely to receive a range of medical services--from preventive
measures
like the flu shot to certain forms of cancer treatment.

But Schneider said he and his colleagues thought their study might
produce
different findings since all participants were covered by Medicare, the
federal health insurance program for Americans aged 65 and older.

"We expected that Medicare managed care might improve access to care for
blacks and that this would translate into a reduction in disparities," he
explained. "Instead, we found that there are racial disparities within
health plans." 

Specifically, data reported to the federal government for 1997 showed
that
about 71% of white women were screened for breast cancer, compared with
63%
of black women. Just over half of white diabetic patients had an eye
exam,
while less than 44% of black diabetics (news - web sites) did so. Because
diabetics are at risk of eye problems related to the disease, regular eye
exams are part of their routine care.

In addition, Schneider's team found that while 74% of white heart attack
patients were put on drugs called beta-blockers, only 64% of African
Americans were. And while more than half of whites who had been
hospitalized
for mental illness received follow-up care, only one third of black
patients
did. 

According to Schneider, the reasons for the disparities are unclear and
could involve numerous factors. The socioeconomic factors his team looked
at--including education and income--appeared to account for only a
portion
of the racial differences.

Schneider noted that there may be race-related differences in patients'
preferences about medical care, as well as differences in the treatments
offered by doctors.

"Most health plans," he said, "have not previously examined racial
disparities in care, but our results suggest that they should."

The findings also underscore how important it is for the federal Center
for
Medicare and Medicaid Services to continue to track the quality of care
in
plans that enroll Medicare beneficiaries, the researchers conclude.

SOURCE: The Journal of the American Medical Association 2002;287:1288-


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