Minority patients typically receive more low-value care than white patients, according to a study published last week in Health Affairs.
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For the study, researchers looked at data on 11 health care services consider to be of low value under the ABIM Foundation's Choosing Wisely program because they are medically unnecessary. The services included:
- Inappropriate cardiac testing;
- Inappropriately using imaging when treating lower-back pain;
- Prescribing opioids to treat migraines; and
- Vitamin D screening.
The researchers examined Medicare administrative data spanning from 2006 to 2011 to identify the amount of low-value services delivered to black, Hispanic, and white Medicare beneficiaries ages 65 and older.
The researchers found that, overall, minority beneficiaries were more likely to receive low-value services than white beneficiaries. Specifically, they found that, when compared with white beneficiaries:
- Hispanic beneficiaries were more likely to receive six low-value health care services; and
- Black beneficiaries were more likely receive five low-value health care services.
For instance, the researchers found that 17 percent of black Medicare beneficiaries with dementia inappropriately received a feeding tube, compared with nearly 13 percent of Hispanic beneficiaries with dementia and fewer than 5 percent of white beneficiaries with dementia. In addition, the researchers said black and Hispanic beneficiaries were more likely than white beneficiaries to receive unneeded cardiac and other preoperative testing, as well as unnecessary imaging when treating enlarged prostates and bone-density testing.
According to the researchers, white beneficiaries were more likely than black or Hispanic beneficiaries to receive a few low-values services, such as cervical cancer screening, imaging for low-back pain, and vitamin D screening.
The study also found that, even among beneficiaries who had higher numbers of physician visits, which the researchers said suggests they had increased access to care when compared with others, black and Hispanic beneficiaries received more low-value care when compared with whites.
William Schpero, a doctoral candidate at the Yale School of Public Health and the lead researcher on the study, said the findings show policymakers should focus on health care inequalities in addition to access to care.
"While our descriptive analysis focused on a small, select set of low-value health care services, it highlights the complexity involved in addressing health care disparities in the United States," he said, adding, "Improving access to care is likely a necessary, but not sufficient part of the policy solution" (Vartorella, Becker's Hospital Review, 6/6; Andrews, Kaiser Health News, 6/9; Greenwood, YaleNews, 6/5; Mangan, CNBC, 6/5).
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