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HARVARD GAZETTE ARCHIVES Black Medicare Bias Found by Researchers By William J. Cromie
Black Medicare patients in Illinois, New York, and Pennsylvania hospitals received poorer basic care than others treated for the same illnesses, according to a study by Harvard researchers. The care included services such as medical history-taking, diagnostic tests, and standard drug treatments given to patients hospitalized with heart failure or pneumonia, the two most common causes of hospitalization for Medicare patients. "Based on other research, the disparities we recorded may have resulted in one additional death among every 200 patients treated," according to John Ayanian, assistant professor of medicine and health care policy at Harvard Medical School. The study revealed that only 32 percent of black pneumonia patients were given antibiotics within six hours of admission, compared with 53 percent of white and other Medicare patients. Also, blacks with pneumonia were less likely to have blood cultures done during the first two days of hospitalization. Other studies have associated prompt administration of antibiotics and collection of blood cultures with lower death rates. "This study casts doubt on the idea that such racial disparities can be explained by patient preference," Ayanian and his colleagues say. Their study examined routine, low-risk noninvasive services unlikely to be refused by any patient. Prior research found that fewer blacks than whites undergo major medical procedure such as kidney transplants and coronary bypass surgery, raising the question of whether this occurs by choice. "Our findings indicate that physicians, nurses, delivery system managers, and policymakers must continue striving to eliminate racial disparities in the quality of medical care," Ayanian comments. The Harvard study, published in the December issue of Medical Care, also concluded that blacks receive better care at teaching hospitals than at other public or private hospitals because urban teaching hospitals provide better care to all patients. Even so, statistically adjusted results showed that blacks received poorer overall treatment for congestive heart failure and pneumonia. These findings were based on reviews of medical records of almost 2,200 Medicare patients, 65 years and older, treated for heart failure and pneumonia at 501 hospitals in the three states in 1991 and 1992. Asked if things may have changed since, Ayanian admitted that "we can't be sure. This is something that needs to be explored further." However, he and his colleagues were reasonably confident of their results because other studies of the disparity in health care between blacks and whites have not changed since 1992. Ayanian says, "We now need to go beyond increased awareness and take specific actions to reduce the racial gap in health care."
Copyright 1999 President and Fellows of Harvard College |