Black and Hispanic populations in the U.S. are more likely to receive unnecessary and potentially harmful healthcare services compared to whites, according to a new Health Affairs study.
The report found that black and Hispanic Medicare patients received services of low value at a higher rate than whites.
"There is a very clear consensus in the literature that minority populations in the U.S. tend to receive lower amounts of effective care," said William Schpero, lead author of the study and a doctoral candidate in the health policy and management department at the Yale School of Public Health.
Schpero and his co-authors analyzed Medicare claims data from 2006 to 2011 as well as 11 treatments identified as low value by the Choosing Wisely initiative, which aims to reduce unnecessary medical tests, treatments and procedures.
Black and Hispanic beneficiaries were significantly more likely to receive seven out of the 11 low-value treatments that evidence-based practice shows are harmful to patients and wasteful of healthcare resources. About 17% of black patients with dementia and 13% of Hispanic patients with dementia received a feeding tube during treatment compared to fewer than 5% of white patients with dementia. Additionally, more than one-third of black beneficiaries received opioid prescriptions for the treatment of a migraine compared to fewer than one-fourth of white beneficiaries.
The study also found that greater use of healthcare services was associated with higher rates of low-value care for five measures among black patients and for six measures among Hispanic patients.
Schpero said the fact that minority populations were still vulnerable to low-value care even with greater utilization of services shows "improving access is important but not the end-all and be-all" to improved care. Efforts that address variation in quality of care between healthcare organizations in different areas should also be an important part of health reform, he said.
There is also increasing interest to tie payment incentives to more efficient care and weed out low-value care. Schpero said there is initial evidence these efforts can help tackle health disparities.
