Racial Gap in Medical Care Remains a Concern

by Ed Stannard, New Haven Register
February 16, 2010

NEW HAVEN — The gap in medical treatment between whites and minority groups may be based partly on which hospitals and doctors they go to when they need surgery, according to a Yale University study.

The study, led by professor Andrew J. Epstein of the School of Public Health, found white patients were more likely than blacks, Hispanics and Asians to go to hospitals where the highest number of procedures was performed.

“There’s concern that racial minorities have less access to care, in our case access to surgeons and doctors,” said Epstein, lead author of the study, which was published in Archives of Surgery, a journal of the American Medical Association.

The researchers looked at 133,821 patients in New York City, comparing which ones went to “high volume” hospitals and doctors to those who did not. The authors assumed the more procedures a doctor or hospital performs, the higher the quality of care, Epstein said.

By basing the study in New York, the researchers could be sure “everyone has reasonable geographic access to hospitals of high volumes,” Epstein said. Still, for nine out of 10 procedures included in the study, blacks tended to go to doctors and hospitals that performed surgeries in lower numbers.

The study also found Asians were less likely to use high-volume hospitals and surgeons for five of the procedures, and Hispanics for four.

“What we found was, especially for African-American patients, there were systematic differences across a range of procedures,” Epstein said.

The procedures included five types of cancer surgery, including breast, lung and colorectal; four cardiovascular procedures, including heart bypass and angioplasty; and hip replacements.

The question the study raised, which will be the subject of future research, is the reason for the phenomenon.

“It could be that historically … if you’re a minority you go to a different set of primary care docs than a white patient,” and those doctors may refer their patients to lower-volume hospitals, Epstein said.

Also, some hospitals “treat higher proportions of minority patients than other hospitals do,” either because of the hospital’s mission or because minority patients tend to be referred to them, he added.

He said he doesn’t believe the discrepancy was the result of racial discrimination.

The white patients in the study tended to be older and wealthier and more likely to have Medicare or health insurance coverage.

Others involved in the study were professor Mark J. Schlesinger of the School of Public Health and Bradford H. Gray of the Urban Institute.

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