Increasing the number of coronary angiography facilities led to a reduction in racial disparities in New Jersey
Research Activities, March 2010, No. 355
To contain health care costs and promote high quality care, States often require health care facilities to obtain approval before offering certain new or expanded services, such as coronary angiography facilities. When New Jersey eased these restrictions, access to angiography (an imaging technique used to diagnose heart problems) increased and eliminated a longstanding racial disparity, a new study finds. Joel C. Cantor, Sc.D., of Rutgers University, and colleagues examined the effect of regulatory reforms between 1996 and 2003 and found that a doubling of angiography facilities closed the gap in blacks' and whites' access to these services. Reducing this disparity was imperative because blacks are at higher risk for heart disease and have higher cardiac death rates than whites.
Interestingly, established centers saw the majority of new patients. For instance, the annual average number of black patients seen at these facilities rose by 817, while new facilities saw an average of fewer than 500 black patients each year. Additionally, the average number of angiography procedures for blacks rose 46 percent for all New Jersey hospitals between the mid-1990s and 2001, with urban hospitals seeing the biggest influx of black patients. Annual utilization among whites rose a more modest 15 percent over the same period, closing the black-white gap in procedure rates.
New Jersey's reforms mandated that new facilities create plans to reach out to patients and linked licensing of other profitable cardiac services to improving access. New Jersey's example shows that it is possible to simultaneously regulate health care offerings and reduce disparities, the authors suggest. Further, lawmakers should use caution when they create policies that limit hospitals from offering profitable services because they may inadvertently create disparities. This study was funded in part by the Agency for Healthcare Research and Quality (HS14191).
See "Reducing racial disparities in coronary angiography," by Dr. Cantor, Derek DeLia, Ph.D., Amy Tiedemann, Ph.D., and others in the September/October 2009 Health Affairs 28(5), pp. 1521-1531.