Equal healthcare access reduces racial disparities

By Megan Rauscher

NEW YORK (Reuters Health) - In an equal access health care system, such as Veterans Affairs (VA) hospitals, the outcomes for African-American patients treated for heart disease are similar to, or better than, those of white patients, new research suggests.

In a setting where differences in access and treatment are minimized, "so are racial differences in functional outcome," Dr. Nancy R. Kressin from the VA Medical Center in Bedford, Massachusetts, colleagues report in the American Heart Journal.

They studied the care and outcome of 793 white and 229 black patients with the same degree of heart disease, namely, the restricted blood flow due to blocked arteries, who were treated at five VA hospitals.

There were some racial differences in the treatments received, especially heart bypass surgery, with blacks less likely to have this procedure than whites, Kressin told Reuters Health.

"But despite this, over time, the African-American patients fared better in terms of their functional status (e.g. their ability to do the tasks of daily living)," she said.

"Although African Americans and whites did not receive identical care, the few differences in outcomes suggest that in this case, different care was not 'disparate' care," she and colleagues conclude.

There's a perception that the VA system provides inferior health care. But Kressin said several recent studies do not support this image of the VA. For example, she cited a 2000 study in which investigators from the Houston VA Medical Center tracked survival after a heart attack among nearly 2,500 veterans and almost 30,000 patients covered by fee-for-service Medicare plans.

In this study, veterans were more likely than Medicare patients to have a history of several ailments, including high blood pressure, diabetes, lung disease, stroke or dementia. But compared with the healthier Medicare patients treated at other hospitals, those treated at a VA hospital were just as likely to be alive one month and one year after a heart attack.

"All of this," Kressin told Reuters Health, "suggests that VA care is of high quality and comparable to care patients get through Medicare or elsewhere in the health care system, which should inspire confidence for veterans receiving their care from the VA."

SOURCE: American Heart Journal, March 2007.