Minorities More Likely Than Whites To Rate Their Health Care as Fair or Poor, Study Finds
Minorities are more likely than whites to rate the quality of their health care as fair or poor, according to a study in the March/April issue of the journal Health Affairs, the AP/San Francisco Chronicle reports. For the study, researchers at Harvard University and the Robert Wood Johnson Foundation surveyed 4,334 U.S. adults in 2007. The researchers asked participants questions such as how quickly they were able to get an appointment the last time they were sick and whether physicians explained conditions and treatments in a way that patients could understand.
The study found that 91% of whites rated their care as excellent or good. For most ethnic groups, the percentage that rated care as excellent or good was lower than that of whites, with the lowest ratings among Chinese-Americans at 74%, blacks born in Africa at 73% and Vietnamese-Americans at 72%.
The study also found that about 63% of whites were able to get a physician appointment on the same day or the day after becoming sick or injured, compared with 42% of Cuban-Americans and 39% of blacks born in the Caribbean. According to the study, about 75% of whites said that physicians listened carefully to them. About 62% of Korean-Americans and 58% of Central or South Americans said their doctors listened carefully to them, the study found.
The study used more detailed categories of ethnic groups than most previous research on health disparities, which "tended to take a broad look at the major ethnic groups even though group members often came from different countries," the AP/Chronicle reports. For example, there were three categories for blacks: those born in the Caribbean, those born in Africa and those born in the U.S. The researchers said the distinctions were important because the best ways to reduce disparities will reflect the unique experiences and needs of different minority groups.
Anne Beal, assistant vice president at the Commonwealth Fund, said the study shows that there are steps health care providers can take to improve the views of minority patients, such as overcoming language barriers. She said government programs, such as Medicare and Medicaid, should pay to incorporate language services into physicians' practices (Freking, AP/San Francisco Chronicle, 3/10).
An abstract of the study is available online.
Elderly Hispanic Care
A separate study, also published in the March/April issue of Health Affairs, found that most elderly Hispanics receive care in hospitals that are highly segregated and provide a lower quality of care for common conditions, the Newark Star-Ledger reports. For the study, lead author Ashish Jha, an assistant professor at Harvard School of Public Health, and colleagues analyzed data from the 4,552 hospitals that serve Medicare beneficiaries. The study focused on care standards such as whether people having heart attacks received aspirin upon arrival or whether antibiotics were delivered in a timely manner to people with pneumonia.
According to the study, 5% of the hospitals cared for more than half of all elderly Hispanics in the U.S., and there was wide variation in the quality of care provided at those hospitals for conditions such as heart attack, pneumonia and congestive heart failure. The study found that hospitals treating a high number of elderly Hispanic beneficiaries were more likely to be for-profit and medium-sized. In addition, those hospitals were less likely in general to have cardiac and medical intensive care units. They also were more likely to be teaching hospitals and have lower nurse-to-patient ratios, according to the study. The hospitals also tended to serve a large number of Medicaid beneficiaries.
Jha said, "It certainly seems to me that we have a long-standing pattern of segregation in our society along racial and ethnic lines, so I'm not surprised to see that spilling over into our health care sector." According to Jha, financial stress from providing care for many low-income patients might contribute to poor quality of care. He added, "The message for policymakers is that if we are serious about improving disparities, we have to do a much better job of reimbursing (hospitals) for caring for the poor" (Stewart, Newark Star-Ledger, 3/11).
An abstract of the study is available online.
Both studies are part of a Health Affairs themed issue that focuses on the links among racial and ethnic disparities and health status and health care. The issue was funded by RWJF and includes studies that address other racial disparity topics, such as social determinants of health, disparities in specific groups and the role of states in addressing disparities (Health Affairs, March/April 2008).