African Americans In Medicare Managed Care Less Likely Than Whites To Get Critical Health Care

African Americans are less likely than whites to receive recommended clinical care in four key quality areas, according to a new study of Medicare managed care enrollees published in the March 13, 2002, issue of the Journal of the American Medical Association (JAMA). The study, supported by The Commonwealth Fund, found that among Medicare beneficiaries enrolled in managed care plans, African Americans were less likely than whites to receive follow-up care after a hospitalization for mental illness (33.2% vs. 54.0%), eye exams if they were diabetic (43.6% vs. 50.4%), beta-blocker medication after a heart attack (64.1% vs. 73.8%), and breast cancer screening (62.9% vs. 70.2%). After adjustment for factors including age, sex, Medicaid insurance, income, education, rural residence region, and plan, racial disparities were still significant for every measure except breast cancer screening. Within the same health plan, African Americans received lower quality of care than whites on three of the measures (follow-up after hospitalization for mental illness, diabetic eye exams, and beta-blockers after heart attack). For the fourth measure (breast cancer screening), the disparity was linked to higher enrollment by African Americans in managed care plans of lower overall quality. "It is disturbing that African Americans are less likely to receive these important components of clinical care, even in situations where health insurance coverage and access to care are supposed to be the same for all beneficiaries," said Karen Scott Collins, M.D., vice president at The Commonwealth Fund. "Data on race and ethnicity have not previously been available to many health plans. Having this information will help them strengthen their quality improvement efforts and eliminate disparities in care as well as raise the level of care for all enrollees." The study was conducted by Eric C. Schneider, M.D., Alan M. Zaslavsky, Ph. D., and Arnold M. Epstein, M.D., from the Harvard School of Public Health and the Harvard Medical School. They are the first researchers to use the Health Plan Employer Data and Information Set (HEDIS) to assess racial disparities in quality of care among Medicare managed care enrollees nationwide, and also the first to use HEDIS to examine racial disparities in the quality of mental health care. Their findings are published in the JAMA article, "Racial Disparities in the Quality of Care for Enrollees in Medicare Managed Care." The findings are consistent with a Commonwealth Fund survey released March 6th disclosing that African Americans age 18 and older experience lower quality of health care than whites on many measures, including effective patient-physician communication and having a regular doctor. The Fund survey also found that African Americans were more likely than whites to feel they had been treated with disrespect in the health care setting.