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More Evidence Minorities in U.S. Get Poorer Hospital Care
Date:10/6/2011

By Alan Mozes
HealthDay Reporter

THURSDAY, Oct. 6 (HealthDay News) -- The United States' so-called "worst" hospitals are home to a significantly larger pool of elderly, poor and minority patients than are the nation's better quality/lower cost institutions, new research says.

While elderly black Americans constitute nearly 7 percent of the patients in the country's 122 "best" hospitals, they make up 15 percent of patients among the nation's 178 "worst" health care facilities, the investigators found.

Elderly Hispanics and Medicaid patients also appear to be over-represented in financially strapped hospitals that were found to have relatively poor health outcomes and higher fatality risks.

The study team also warns that the situation among the country's most beleaguered facilities is poised to get worse, given the reward system outlined in the new U.S. health care law, which will empower Medicare and Medicaid to cut payments to hospitals that don't meet designated quality standards.

"What we're taking about is a new regime in which we're going to see big cuts in payments from Medicare, which is the biggest payer of hospital care in this country," said study lead author Dr. Ashish K. Jha, an associate professor in the department of health policy and management at the Harvard School of Public Health.

"And anytime you have this kind of change there are going to be winners and losers," Jha added. "The hospitals that are most at risk for coming out on the losing end -- the ones that are already faring poorly -- are also those who care for the most vulnerable populations."

Jha and his colleagues present their findings in the October issue of Health Affairs.

For the study, the authors looked at patient populations and care quality at about 3,200 hospitals across the United States.

The hospitals that ranked in the top quarter in terms of providing the highest quality of care and the lowest quarter in terms of cost were deemed the "best." The so-called "worst" hospitals fell into the lowest quarter in terms of care quality and the highest quarter in terms of cost.

The difference between a "best" and "worst" designation can be the difference between life and death for someone with heart disease or pneumonia, the study authors said. For example, heart-attack patients were found to face a 7 percent to 10 percent higher risk for dying at one of the worst hospitals, compared to similar patients at the best.

The authors observed that the best hospitals were more often in the Northeast, and were more likely to be non-profit facilities outfitted with more state-of- the-art equipment for such problems as cardiac illness.

The worst institutions were more likely to be for-profit or public facilities, and were more likely to be located in the South.

In addition to the doubling of black patient populations in the worst institutions, the study authors also noted that while Hispanics accounted for just 1 percent of the patient pool in the best hospitals, they made up 4 percent in the worst. Similarly, while Medicaid patients accounted for just 15 percent of all patients in the best facilities, they constituted 23 percent among the worst.

"Now I want to stress that there is nothing inherent about caring for poor or minority patients that should make it so that it is inevitable that they be subject to lower-quality care," said Jha. "But the truth is that we see it over and over again."

Dr. Ali Salim, an attending surgeon and program director of the General Surgery Residency Educational Program at Cedars-Sinai Medical Center in Los Angeles, expressed little surprise with the study findings.

"First off, it should be said that these points made in this study are all just associations," he cautioned. "There is no cause and effect that can be gleaned by their observation.

"But this is definitely an important and interesting study," added Salim, who is also a trauma surgeon. "And the findings conform closely to what we see out there in practice. I can say for sure that we see it in trauma care, among those safety-net hospitals that care for a higher proportion of minorities. These facilities tend to have worse outcomes regardless of their insurance status or their race."

A Johns Hopkins School of Medicine report published in the Archives of Surgery last month highlights Salim's point, concluding that patients of all races face worse outcomes and a greater risk for death when treated at trauma centers that serve a higher proportion of minority patients.

More information

For more on minorities and health care disparities, visit the U.S. National Association of Public Hospitals and Health Systems.

SOURCE: Ashish K. Jha, M.D., associate professor, department of health policy and management, Harvard School of Public Health, Boston; Ali Salim, M.D., attending surgeon and program director, General Surgery Residency Educational Program, Cedars-Sinai Medical Center, Los Angeles; October 2011, Health Affairs


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