Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
Copyright 2002 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.2002
To the Editor: Dr Schneider and colleagues1 found that black patients in Medicare managed care
organizations (MCOs) had poorer quality of care than white patients. Although
numerous studies have reported racial disparities in health care, few have
examined whether physician characteristics or treatment recommendations contribute
to these disparities.2- 4
We previously reported that Hispanic and black patients with severe coronary
artery disease were less likely than white patients to have revascularization
recommended after angiography.2 However,
hospital records of patients for whom medical therapy was recommended revealed
that medical factors, such as diffuse disease, precluded some patients from
undergoing the procedure. In addition, nonmedical factors, such as patients'
refusal of the physician recommendation for revascularization and preference
for conservative medical therapy, contributed to our findings. This suggests
that clinical as well as nonclinical or psychosocial factors account for disparities
in cardiac care, with overt racial/ethnic discrimination less likely. Such
factors cannot be gleaned from large administrative databases such as those
used by Schneider et al.
Barnhart J, Wassertheil-Smoller S. Racial Disparities in Health Care. JAMA. 2002;287(22):2942-2943. doi:10.1001/jama.287.22.2942