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Eric C. Schneider, MD,MSc; Alan M. Zaslavsky, PhD; Arnold M. Epstein, MD,MA

JAMA. 2002;287:1288-1294.

Context  Substantial racial disparities in the use of some health services exist; however, much less is known about racial disparities in the quality of care.

Objective  To assess racial disparities in the quality of care for enrollees in Medicare managed care health plans.

Design and Setting  Observational study, using the 1998 Health Plan Employer Data and Information Set (HEDIS), which summarized performance in calendar year 1997 for 4 measures of quality of care (breast cancer screening, eye examinations for patients with diabetes, -blocker use after myocardial infarction, and follow-up after hospitalization for mental illness).

Participants  A total of 305 574 (7.7%) beneficiaries who were enrolled in Medicare managed care health plans had data for at least 1 of the 4 HEDIS measures and were aged 65 years or older.

Main Outcome Measures  Rates of breast cancer screening, eye examinations for patients with diabetes, -blocker use after myocardial infarction, and follow-up after hospitalization for mental illness.

Results  Blacks were less likely than whites to receive breast cancer screening (62.9% vs 70.9%; P<.001), eye examinations for patients with diabetes (43.6% vs 50.4%; P = .02), -blocker medication after myocardial infarction (64.1% vs 73.8%; P<.005), and follow-up after hospitalization for mental illness (33.2 vs 54.0%; P<.001). After adjustment for potential confounding factors, racial disparities were still statistically significant for eye examinations for patients with diabetes, -blocker use after myocardial infarction, and follow-up after hospitalization for mental illness.

Conclusion  Among Medicare beneficiaries enrolled in managed care health plans, blacks received poorer quality of care than whites.

Author Affiliations: Department of Health Policy and Management, Harvard School of Public Health (Drs Schneider and Epstein), Section on Health Policy, Division of General Medicine, Brigham and Women's Hospital (Drs Schneider and Esptein), and the Department of Health Care Policy, Harvard Medical School (Dr Zaslavsky), Boston, Mass.

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