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Study says blacks get poorer health care in Medicare managed care plans

CHICAGO (AP) _ Blacks get poorer quality care than whites when it comes to mental illness and certain other ailments, a study of patients enrolled in Medicare managed-care plans suggests.

While other studies have found broad racial inequities in medicine, this is one of the first to show it exists in mental health treatment, the researchers said.

The reasons for the gap found in the study are unclear, but the researchers said lack of access to medical care _ a reason cited in other research _ is unlikely because they compared blacks and whites enrolled in similar plans.

``So the fact that there are still these differences is somewhat striking,'' said Dr. Eric Schneider of Harvard University's School of Public Health, who led the study.

He said the possible explanations include racial bias among doctors and cultural differences, including a tendency among some blacks to shun some preventive health care measures.

The study involved 305,574 patients in more than 200 Medicare managed care plans in 1997. The findings appear in Wednesday's Journal of the American Medical Association. Patients were 65 or older.

Blacks were less likely than whites to receive follow-up care after being hospitalized for mental illness, 33.2 percent versus 54 percent; and less likely to receive commonly used beta blockers after heart attacks, 64 percent versus 73.8 percent. Black diabetics were less likely than white diabetics to receive eye exams, 43.6 percent compared with 50.4 percent.

There was also evidence that black women were less likely to get breast cancer screening such as mammograms, though that difference became insignificant when the researchers took into account other possible factors.

While the study did not evaluate whether the disparities resulted in poorer results for blacks, it is likely that many fared worse than whites, Schneider said.

``One could imagine that there would be untreated mental illness and all of the possibilities that would go along with that,'' such as relapse and readmission to hospitals, he said.

Peggy O'Kane, president of the National Committee for Quality Assurance, said the results are not at all surprising.

``We see this no matter where we look in health care,'' O'Kane said. ``We need to push beyond recognition that this is a problem and really start to understand better the factors that are causing this.''

Ruben King-Shaw Jr., chief operating officer at the Center for Medicare & Medicaid Services, the federal agency that oversees Medicare programs, said the study is reason for concern. He said it provides useful information for the agency's efforts to address the racial gap.
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