Academic journal article Health Care Financing Review

Differences by Race in the Rates of Procedures Performed in Hospitals for Medicare Beneficiaries

Academic journal article Health Care Financing Review

Differences by Race in the Rates of Procedures Performed in Hospitals for Medicare Beneficiaries

Article excerpt

INTRODUCTION

The 1965 Medicare legislation was intended to reduce financial barriers to hospital and physicians' services for the elderly population in the United States. The implementation of the Medicare program meant that virtually the entire population 65 years of age or over became covered for Medicare Part A hospital services and entitled to enroll voluntarily in the Medicare Part B physicians' and related services program. As a condition of participation in the Medicare program, hospitals were required to be in compliance with title VI of the Civil Rights Act of 1964. Title VI requires that no one be excluded, on the ground of race, color, or national origin, from benefits under any program receiving Federal financial assistance. As observed by Myers (1970), the Medicare legislation, almost overnight, brought an end to segregation in hospitals. Thus, the Medicare program could be expected to improve access to physicians' and hospital services for all of the elderly in the Nation. However, some predicted that the discrepancies in access to health care services would very likely not fully disappear (Bergner and Yerby, 1968).

Early reports prepared from Medicare administrative data showed that the hospital discharge rate for beneficiaries of races other than white in 1967, the first full year of Medicare, was only 71 percent of the rate for white beneficiaries - 189 discharges per 1,000 enrollees for races other than white, compared with 266 discharges per 1,000 white enrollees (Social Security Administration, 1975). In succeeding years, the hospital discharge rate increased, rising faster for beneficiaries of races other than white than for white beneficiaries. By 1986, the higher discharge rates for white persons had disappeared, and, by 1992, the rates were 10 percent higher for black beneficiaries.

However, more detailed examination of Medicare administrative data for hospitalizations in 1986 showed differences by race in the rates of many procedures. Rates for 14 major procedures were consistently lower for black beneficiaries compared with white beneficiaries (Health Care Financing Administration, 1990). Data for subsequent years indicated that the differences by race in the procedures studied persisted through the end of the decade (Health Care Financing Administration, 1992, 1993, 1994).

Other studies have focused particularly on differences by race in the use of heart procedures. Wenneker and Epstein (1989) analyzed 1985 hospital discharge data from Massachusetts and reported lower rates of coronary angiography and coronary artery bypass graft (CABG) surgery for black persons admitted for circulatory disease or chest pain compared with white persons admitted for the same diagnoses. They found no differences in the rates of percutaneous transluminal coronary angioplasty (PTCA). Udvarhelyi et al. (1992) examined Medicare administrative data for these same procedures performed for Medicare patients hospitalized in 1987 with acute myocardial infarction (AMI). They found that black beneficiaries had substantially lower rates of cardiac catheterization, CABG surgery, and PTCA in the 90 days following the AMI, although 2-year survival was the same in both races. Similarly, Whittle et al. (1993) showed that white veterans treated in Veterans Affairs hospitals from 1987 through 1991 were more likely to undergo cardiac catheterization, PTCA, and CABG surgery. In our analysis of trends for Medicare beneficiaries in the last half of the 1980s, we found substantial differences by race in CABG surgery and PTCA (McBean, Warren, and Babish, 1994). Thus, information from several different data sources from the last half of the 1980s has highlighted greater use of surgical procedures, particularly cardiac procedures, in white persons compared with black persons.

Recently, Escarce et al. (1993) used Medicare Part B data for 1986 to examine differences by race in a number of non-surgical and surgical procedures. …

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