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Medicare Marked by Widespread Racial disparities

Older whites are likelier than older black adults to have their blood sugar, blood pressure, and cholesterol under control//, although the even if they belong to a high-quality Medicare plan, researchers reported Tuesday.

The findings, published in Wednesday's Journal of the American Medical Association, show that racial disparities are common throughout the Medicare system.

Lead study author Dr. Amal N. Trivedi of Brown University in Providence, Rhode Island said, "This is not a limited problem within a few health plans. It's something they'll all have to address."

The extent to which patients have their blood pressure, cholesterol and blood sugar under control is considered a key indicator of health plan quality. Although studies have long pointed to health disparities between white and black Americans, new research shows that this is not necessarily due to black Americans choosing lower-quality health plans.

Trivedi's team analyzed around 151 Medicare health plans and found racial disparities within individual plans, including "high-performing" ones where a good percentage of patients were observed to have their high blood pressure, cholesterol or blood sugar in check.

On the whole it was found that the proportion of African Americans who had these conditions under control was 6.8 to 14.4 percentage points lower compared with whites.

Trivedi said, "We know that people who have their blood pressure, cholesterol and blood sugar controlled are less likely to have a heart attack, stroke or die prematurely."

He said that it would therefore be important to address the racial gaps this study uncovered. Trivedi noted that one of the obstacles is that although the federal government requires Medicare plans to report data on overall quality of care, most plans do not collect information on the race and ethnicity of their members. "So many of these plans may be unaware they have racial disparities," he sa id.

Trivedi and his colleagues proposed that the federal Medicare program work with individual plans so that ways of monitoring racial gaps in care are developed.

Trivedi said, "You can't improve what you don't measure." Still reasons for these racial disparities within the same health plan are still not clear. Trivedi said that the study measured certain demographic factors, like income and education, and these explained only some of the healthcare gap.

He noted that the problem was most likely multifaceted, involving factors such as differences in the individual doctors black and white patients see, and differences in diet and other lifestyle habits.


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