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Elderly blacks and whites enrolled in Medicare managed care plans do not receive the same quality of care

Blacks are less likely to receive medical procedures than whites, even though they bear a greater burden of chronic illness, such as hypertension and diabetes. It was thought that managed care programs that required enrollees to choose a primary care physician, had targeted outreach to special needs populations, provided case management programs for patients with chronic diseases, and used enhanced quality monitoring might lessen racial disparities in quality of care. It seems, however, that this is not the case for Medicare managed care patients, according to a recent study supported in part by the Agency for Healthcare Research and Quality (HS10803).

Alan M. Zaslavsky, Ph.D., of Harvard Medical School, and his colleagues examined data from the 1998 Medicare Health Plan Employer Data and Information Set on four measures of quality of care for 305,574 elderly patients enrolled in Medicare managed care health plans. Results revealed that blacks were less likely than whites to receive breast cancer screening (63 vs. 71 percent), eye examinations for patients with diabetes (44 vs. 50 percent), beta-blocker medication after heart attack (64 vs. 74 percent), and followup after hospitalization for mental illness (33 vs. 54 percent). Even after adjusting for other factors affecting quality of care, these racial disparities remained significant for all measures except breast cancer screening.

These differences in clinical services could be associated with poorer health outcomes observed among minority patients compared with white patients, suggest the researchers. They found that more than half of the racial disparity in breast cancer screening was explained by socioeconomic factors such as income and education, but less than one-tenth of the racial disparity in followup after hospitalization for mental illness was explained by these factors. Finally, part (but not all) of the racial disparity in clinical quality was explained by disproportionate enrollment of blacks in health plans with poorer performance.

See "Racial disparities in the quality of care for enrollees in Medicare managed care," by Eric C. Schneider, M.D., M.Sc., Dr. Zaslavsky, and Arnold M. Epstein, M.D., M.A., in the March 13, 2002 Journal of the American Medical Association 287(10), pp. 1288-1294.

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