A recent study on racial disparities in health care found that urvival rates after surgery at teaching hospitals are worse for black patients than for white patients
Arch Surg -- Hospital Teaching Intensity, Patient Race, and Surgical Outcomes, February 2009, Silber et al. 144 (2): 113
Another interesting finding was that patients undergoing surgery at hospitals with high teaching intensity (defined as 0.6 resident per bed) had a 15% lower risk for death and a 15% lower risk for death after complications than patients at nonteaching hospitals (P< 0.001 for both comparisons). This is a topic for another time, but I think it reinforces the critical role that academic medical centers play in providing high quality health care in America, and though we pay more for care at AMCs, it appears we are receiving higher quality for that additional cost.
But back t0 equity in health care - as an internist, I'm most aware of the literature on racial disparities in cardiology. I haven't seen literature on surgical outcomes, but this is consistent with what is published in the internal medicine literature.
The Kaiser Family Foundation and the ACC did a retrospective literature review and found that
• Of the 81 studies investigating racial/ethnic differences in
cardiac care from 1984 to 2001, 68 find racial/ethnic
differences in cardiac care for at least one of the minority
groups under study.
• Of the 68, 46 find differences in cardiac care for all of the
procedures and treatments investigated, and 22 find
differences in cardiac care for some procedures and
treatments and not others.
• The 13 remaining studies include 11 that find no
racial/ethnic differences in cardiac care,1 and two that find
the racial/ethnic minority group more likely than whites to
receive appropriate care.
In all health system reform, we must think about how we balance access, cost and quality. Our national conversation has been frenetically touching upon all three (i.e. - health insurance exchanges, cost effectiveness panels, medical homes), but this research makes me think the ingredient of equity has largely been missing, or is sitting on the back burner. We must not forget this piece, as we push forth health reform in America.
Thursday, February 19, 2009
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When I worked in the UK, equity was a huge issue. I worked with a care trust in a region that was affluent, but had a section of poorer people. Promoting and achieving equal access to care and equal health outcomes among different socioeconomic classes was the issue they clearly care most about. I am curious what you are finding in your work there.
ReplyDeleteIt's interesting that this appears to be a big issue in the UK. They are ahead of the US in terms of access and cost, but they show us that this is not enough, that it does not end the debate.
One of the primary care trusts in the NHS is trying to deal with the problem of health variation among the "gypsies". Really??!? Gypsies? It's just wrong...
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