health care disparities

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Medical Segregation: Most Minority Patients See Minority Doctors

A Hispanic couple consult with an Asian doctor (National Cancer Institute via Wikimedia Commons)

A Hispanic couple consult with an Asian doctor (National Cancer Institute via Wikimedia Commons)

A paper just out in the journal JAMA Internal Medicine finds a striking state of segregation in American medicine: “Nonwhite physicians cared for 53.5% of minority and 70.4% of non–English-speaking patients,” sums up the study, which was led by Cambridge Health Alliance doctors.

And that racial-ethnic split has changed little since a similar look a quarter-century ago, the paper notes.

As Obamacare kicks in, the rolls of the newly insured are expected to include many members of minorities and recent immigrants. Those newly covered people are expected to boost the demand for doctors, particularly in primary care. But will they be able to get access to care?

From the press release:

“There is a lot of concern that there will not be enough physicians willing and able to care for them,” said Danny McCormick, MD, MPH, the study’s senior author, a physician at Cambridge Health Alliance, and an associate professor of medicine at Harvard Medical School. “In order to increase the number of Black and Hispanic physicians, medical schools will need to more fully consider the physician workforce needs of the health care system as a whole in admissions decisions.”

An accompanying commentary in JAMA Internal Medicine calls for medical schools to admit more minority applicants, even if some of their science and other academic scores are lower, because minority physicians show more commitment to serving poor and minority populations.

The study’s lead author, Dr. Lyndonna Marrast, argues similarly: “Medical schools need to redouble their efforts to recruit and train minority students,” she said, “and we need policies at both the federal and institutional levels on a much larger scale than what we have now.”

These efforts to train more minority doctors would be “stopgap measures,” she said, because “ideally, we would live in integrated neighborhoods and everyone would have equal access to health care. Instead, we have members of society who are from marginalized groups, often geographically and culturally isolated, and they have a hard time accessing health care.”

How about getting more white doctors to serve more minorities? Continue reading

Turnbull: On Inequality In Medical Spending And The Cost Hearings

Nancy Turnbull, Harvard School of Public Health

By Nancy Turnbull
Associate Dean of the Harvard School of Public Health

It might be the effects of the thin air here in Colorado, but I am disappointed to be missing the second annual hearings on health care cost trends, which will take place this week. In preparation for the hearings, a flurry of reports, testimony and other material has been issued, all of which is posted on the website of the Division of Health Care Finance and Policy. Lots of interesting early morning reading for someone who hasn’t adjusted to Mountain Time.

Among the most important findings in the new reports is that medical spending is greater for people who live in zip codes with higher incomes than spending in zip codes with lower average income. This correlation was found both in the report of Attorney General Martha Coakley’s office and in one of the reports from the Division of Health Care Finance and Policy. While zip code of residence is not a perfect predictor of any individual’s income, it’s a pretty good proxy, on average.

The fact that average medical spending per person tends to be higher in higher income zip codes than in lower income zip codes, even after correcting for underlying health needs, is actually not really surprising. We know from existing research over many years that there is significant income-related inequality in medical spending in the United States. But these reports are, as far as I know, the first to document these disparities in Massachusetts. And, since the reports look only at people who have private insurance, these spending differences are not due to insurance status. (Lower-income people are more likely to not have any insurance and medical spending is much lower for uninsured people. But these reports consider only insured people with private coverage, and they also adjust spending for health status, two of the factors that would be most likely to account for differences in medical spending by income.)

Income-related inequalities in medical spending are particularly troubling because we know that people with lower incomes have higher health needs. Being a lower income person in the U.S. is bad for your health. So we would expect medical spending to be higher for people with lower incomes. Instead, it’s just the opposite. These inequalities are also cruelly ironic, since the financing of private health insurance is already so regressive: in the individual market and at most employers, the best paid person pays the same premium as the lowest paid person for the same health insurance coverage, which means that lower income people pay a higher proportion of their income for private health insurance. Continue reading