Eldercare
A major study examining differences in the health care that black and white seniors receive will be published in the Aug. 18 issue of the New England Journal of Medicine. The study, funded by the Robert Wood Johnson Foundation (RWJF) and conducted by a research team led by Ashish Jha, M.D., M.P.H., and Arnold Epstein, M.D., M.A., of the Harvard School of Public Health, and Elliott Fisher, M.D., M.P.H., of Dartmouth Medical School, found that during the 1990's, up to 2001, blacks received significantly fewer surgeries that help seniors live better and longer lives compared to whites. The study also found that in many cases, these differences in care are getting worse.
"For more than 20 years we have known that black Americans receive a different level of care than whites," said Jha, Assistant Professor of Health Policy and Management at the Harvard School of Public Health. "Despite concerted efforts to address these disparities, this study shows that black seniors continue to receive fewer surgical procedures than whites. On a fundamental level, these differences in care are not acceptable."
The study, the first to look at the use of major, potentially life-saving surgeries among black and white seniors, examined how often nine types of surgical procedures, ranging from heart bypass surgery to total hip replacement, were performed on Medicare enrollees from 1992 to 2001. The analysis shows that in 1992, white patients had higher rates for each of the nine types of procedures. By 2001, not only had the gap failed to substantially decrease in eight of the procedures, it had instead increased sharply in five: back surgeries, valve replacements, hip replacements, knee replacements, and appendectomies.
"When you look at this problem of racial differences over a long period of time, you would hope to see marked reduction in the disparities between the care black and white patients receive," said Epstein, John H. Foster Professor and Chairman of the Department of Health Policy and Management at the Harvard School of Public Health. "When we examined these potentially life-saving surgeries, we didn't see any areas of the country where these disparities were eliminated."
"Studies like this one create an even greater urgency for the Foundation's mission to improve the quality of care for all Americans," said Risa Lavizzo-Mourey, M.D., M.B.A., President and CEO of the Robert Wood Johnson Foundation. "We hope that it will also succeed in engaging others to join us in the effort to find solutions to racial and ethnic gaps in treatment. Solutions will need to involve all those who have an impact on the quality of health care, such as the federal and state governments, patients and consumers, physicians, hospitals, and health plans."
The study is also significant because of the scope of the data analyzed. By using Medicare enrollees as the sample population, the study examined care for nearly 40 million Americans.
"Looking at these trends over time helps everyone to understand the level of effort that will be needed to address the problem of racial and ethnic disparities in care," said Fisher, Professor of Medicine and of Community and Family Medicine at Dartmouth Medical School. "It's important to monitor the problem, it's equally important to start focusing on solutions."
To view the full report, "Trends in the use of major procedures among the elderly: Are racial differences narrowing?" visit the New England Journal of Medicine Web site at content.nejm.org or www.rwjf.org
Data for the study were provided by the Dartmouth Atlas Project, www.dartmouthatlas.org
Data for selected regions of the country can be obtained at www.hsph.harvard.edu