Minorities, whites get equal care in U.S. hospitals

A University of Maryland study of whether people receive different quality of hospital care because of their race or ethnicity found that when whites and minorities are admitted to a hospital for the same reason, they receive the same quality care in that hospital.

The study led by Darrell Gaskin, health economist in the University of Maryland's department of African American Studies, appears in the March 11 issue of Health Affairs. The study of 1841 hospitals in 13 states compares the quality of treatment for blacks, Hispanics and Asians to that of whites over a broad range of services. It found that only a few hospitals provide lower quality care to minorities than to whites.

"The good news," said Gaskin, "is that if you come to the hospital for care, you're probably getting the same quality as everyone else in that hospital."

The study also may help pinpoint where improvements need to be made to reduce the significant health care disparities that are known to exist because of race, ethnicity and income. "Our study confirms that all patients in low performing hospitals are at higher risk for mortality and complications. We need to focus on improving those low performers as opposed to hospitals nationwide," Gaskin said. "Our results also suggest that we need to look more carefully at other areas to find where disparities are originating, such as getting access to the good hospitals in the first place."

Surprised at Findings

Gaskin admits he was surprised at the results of the three-year study. Earlier studies that looked at only a few specific conditions, such as cardiac care, and used general estimating equations, have shown quality differences based on race.

What made this study different, Gaskin said, is that "we compared a broader range of services and directly compared hospital-specific quality indicators for racial and ethnic groups. We examined rates of mortality and complications - whether something bad happened in the hospital because of the care."

Gaskin's group looked at hospitals in 13 states that report patients' race and that collect the specific data the researchers needed to compute quality measures. Forty-four percent of the U.S. population live in these states, with 36 percent of Asians, about 50 percent of Hispanics, 46 percent of African Americans and more than 44 percent of whites residing in the areas studied. The study covered more than 45 percent of urban hospitals and 28 percent of rural hospitals.

"The findings indicate that the systems in place in the hospitals do work to deliver equal quality to patients in that same hospital. It's difficult for one person's bias to make a difference in treatment that would show in mortality rates," Gaskin said.

Gaskin is now working on a study to examine minorities' access to quality medical care, particularly how primary care affects equal access. "We have a tremendous problem with minorities, especially blacks and Asians, getting access to the good hospitals or being referred for care when it could make the most difference. The access problem isn't going to be solved in the hospital. It has to be solved in communities."

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More revelations about a disgusting Australian health bureaucracy

QUEENSLAND Health Minister Stephen Robertson is in the Torres Strait today to get a first-hand look at security for health workers. Nurses are threatening to strike from March 28 if security does not improve in the state's remote north. A nurse was raped on remote Mabuiag Island in the Torres Strait last month and was told to return to work after the attack, receiving no help to leave the island. Mr Robertson has been under fire this week over his handling of health workers' security issues. A spokesman said the minister was visiting a number of islands in the region to inspect progress on security improvements.

Yesterday remote area nurse Janine Evans, 43, broke her silence to reveal how health authorities exposed her to danger by failing to tell her about a written threat to her safety while working at Hopevale, on Cape York; and later heartlessly hauled her through the courts over taking a work vehicle to escape another community.

It took at least three weeks before a Cairns-based manager informed Ms Evans about the letter, from the family of a patient, which warned she should never work with Aboriginal people again and "if we see her on her days off she should watch out". In an extraordinary admission last night, Queensland Health said it had no specific policy for staff if they received written or verbal threats. "Anyone with fears for their safety should contact police," a spokeswoman said. Ms Evans said: "I just think it's terrible to leave me in there when they knew about the threats," she said.

Ms Evans was later taken to court over a work vehicle she used to escape Coen, on Cape York. She fled because she was struggling to cope, blaming a lack of support. The latest allegations show that the crisis in remote health is not just confined to the Torres Strait, where nurses are threatening to strike from March 28 if conditions do not improve.

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