Disparities found in health care for blacks
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But researchers are still trying to determine what is behind the differences. Other studies have shown that access to health insurance is a factor, and some have found that doctors consciously or subconsciously discriminate against black patients.
Christine Ferguson, commissioner of public health in Massachusetts, said racial disparities in health are a top priority. She said she believes that ''you can't just move people into different health practices and expect to get better outcomes," because lack of insurance and low reimbursement by government insurance programs are also involved.
''We need to figure out a way to help physicians make the connections with specialists and labs," she said. ''We have to look at training and reimbursement."
She said her department is considering whether to require health agencies that contract with the state to demonstrate improvements in outcomes for blacks and other minorities.
A physician practicing in Mattapan said the study didn't ring true. Dr. Jean Nazaire, a pediatrician for 29 years, said 95 percent of his patients are black and he has no trouble securing specialty care for them because of affiliations with three Boston hospitals. ''Most of the black physicians I know are board-certified," he said -- meaning they have demonstrated skill in their specialty by passing a test. Nazaire said he believed the racial disparities in health were due more to patients' lack of insurance and their own ''negligence" in maintaining their health.
Bigby also cautioned about concluding that board certification is a good measure of a physician's ability. She said blacks score worse on the exams than whites, as they do on most standardized testing, and that test bias rather than skill may be involved.
However, she and others said the study reinforces what earlier studies have suggested.
For example, a study of primary care doctors in New York City found that those who treated minorities were less knowledgeable about prevention and less likely to be certified in specialty areas than those who treated whites. And a study of cardiac care found that doctors who performed cardiac surgery on blacks were less qualified than those doing surgery on whites.
The new study analyzed more than 150,000 primary care visits by black and white patients over age 65 who had Medicare coverage. In addition, researchers questioned the 4,355 doctors seen by those patients in 60 cities, including Boston, about how often they could arrange specialty care for patients.
Bach said they focused on primary care because it is the gateway to the medical system for most patients. They believe the findings are applicable to patients of other ages because few of the doctors restricted their practice to seniors. But Bach cautioned that the study did not look at what care the patients actually received.
The researchers found that 22 percent of the doctors nationally accounted for 80 percent of the visits by black patients and only 22 percent of visits by white patients. These doctors, most of whom were white, provided more free care, treated more patients insured by the government's Medicaid insurance program for those with low incomes, and were more likely to practice in low-income neighborhoods, the study found. Seventy-seven percent of them had board certification in their primary care specialty, compared with 86 percent of doctors who mainly treated white patients.
Black patients seemed to seek out black doctors, seeing them 22 percent of the time, while whites saw black doctors less than 1 percent of the time. Nationwide, 5 percent of physicians are black.
Nearly 28 percent of physicians primarily treating blacks said they could not provide access to high-quality care for all their patients, compared with only 19 percent of doctors primarily treating whites.
''This paper supports the notion of institutional racism," said Bigby. ''The health care system is set up in such a way that some patients have less access to services."
© Copyright 2004 Globe Newspaper Company.