Study Finds Significant Racial Disparities in Quality of Care for Participants in Medicare Managed Care Plans
For immediate release: March 12, 2002
Boston, MA – Researchers from the Harvard School of Public Health and the Harvard Medical School analyzing national Medicare data on the quality of care in managed care plans, have found that black enrollees received poorer quality of care than white enrollees. The study results appear in the March 13, 2002 edition of the Journal of the American Medical Association (JAMA).
The researchers looked at four important measures of clinical quality; breast cancer screening, use of beta-blockers after heart attack, eye examinations for patients with diabetes and follow-up after hospitalization for mental illness, and found that blacks were less likely to receive each of them. Breast cancer screening among the study participants was done for 62.9 percent of black enrollees compared to 70.9 percent of whites, eye exams were given to 43.6 percent of black patients with diabetes compared to 50.4 percent for whites with the condition, beta-blockers were administered after heart attack to 64.1 percent of blacks compared to 73.8 percent for whites and follow-up after hospitalization for mental illness was performed for 33.2 percent of blacks compared to 54 percent for whites.
Using the 1998 Medicare-specific version of the Health Plan Employer Data and Information Set (HEDIS) developed by the National Committee for Quality Assurance (NCQA) to assess the quality of health plans, the researchers compared quality of care measurements among a sample of more than 305,000 enrollees, age 65 or older, in managed health care plans selected from approximately 4 million beneficiaries enrolled in health plans.
Additional socioeconomic factors were associated with differences in clinical quality of care. Beneficiaries with Medicaid insurance, low income, or lower educational attainment levels were less likely to receive the four clinical services measured in the study. The researchers also examined whether racial disparity in clinical quality occurs predominantly between health plans (disproportionate numbers of blacks enrolled in health plans with poor performance) or within health plans (because the quality of care is lower for blacks than whites within the same health plans). They found that for breast cancer screening, the disparity appeared due to disproportionate enrollment of blacks in health plans with poorer performance, but for the other measures, there was a difference in quality for blacks and whites within the same health plans.
"The good news here is that for breast cancer screening the gap in disparities between blacks and whites in managed care plans is smaller than prior studies have found," said Eric Schneider, lead author of the study and a researcher in the Department of Health Policy and Management at the Harvard School of Public Health. "On the other hand, the level of disparity for blacks receiving follow-up after hospitalization for mental illness has not been studied before and the gap in quality of service is quite large. Overall, the results suggest that all categories of health plans need to make special efforts not only to improve the quality of care for all enrollees, but also to address the issue of racial disparities and strive toward eliminating them."
The study was supported by grants from the Commonwealth Fund and the Agency for Healthcare Research and Quality.
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