Segregation reduces access to surgery: study
NEW YORK (Reuters Health) - In US counties with the most segregation, an increase in the African-American or Hispanic population is associated with a decrease in the availability and use of surgical services and an increase in the number of emergency room visits, a new study shows.
The results of the study, the researchers say, provide more evidence that minority groups in the US have comparatively poorer access to a range of health care services, often resulting in late diagnosis of illness and delayed treatment.
Dr. Awori Jeremiah Hayanga from the University of Michigan Health System, Ann Arbor, and colleagues report their study in the Journal of the American College of Surgeons.
"The federal government will not achieve the goals laid out in Healthy People 2010 (to eliminate health disparities)," Hayanga told Reuters Health, "not because of a lack of benevolent intent today but instead due to the structural shortsightedness of the past."
Hayanga and colleagues examined the effects of segregation on disparities in access to outpatient surgical care and the use of emergency services among minorities at the county level.
"In the most segregated counties, we found that an increase as small as one percent in the African-American or Hispanic population was associated with a significant decrease in the availability and utilization of surgical services, a difference that was not present in counties with the least segregation," Hayanga noted in a statement.
There was also a decrease in the average number of primary care doctors, but this decrease was not statistically significant.
Similarly, in the most segregated counties, a one percent increase in either minority population was associated with a significant decrease in the number of outpatient surgical procedures performed.
The researchers also found that any increase in the Hispanic or African American population in these counties was associated with a significant increase in the number of emergency visits per county.
"This report should guide budgetary decisions and incentives by health policy makers in their bid to close the racial health disparity gap and to strive to increase access to surgical health care across racial lines, particularly in areas identifiable for being the most segregated," the investigators say.
Doctors, Hayanga added, need an incentive "to relocate and move to these areas that need them the most. The distribution of providers is more complex than decisions based on salary and individual gain, and so the desire to serve must not be diluted by the structures established in a previous era and instead reflect the very ideals that led to the decision to become a doctor in the first place."
"I am currently looking at the distribution of surgical workforce in the US with specific attention to underserved areas with a view to attempting to identify how these may best be remedied," Hayanga said.
SOURCE: Journal of the American College of Surgeons, June 2009.
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