Separate and Unequal Access to Health Care?

Research finds black patients, despite living closer to high-quality centers, receive treatment in lesser hospitals.

Segregation is still real. Although black-white segregation has, overall, declined steadily since the 1970s, major American metros remain split into black and white areas.

A report by the Urban Institute spells it out: "We are a less segregated country than we were 10 years ago," but it "is also troubling that metros with large populations, and large black populations, aren't seeing that progress. New York, Chicago, and Philadelphia are all hardly more integrated than they were 40 years ago." (The Atlantic Cities has an authoritative series on the topic that is worth checking out.)

If segregation is still real, the negative consequences of it are as well. One of those consequences is the disparity when it comes to health care between blacks and whites. The fact that black patients have poorer outcomes in surgery has been well documented. One study conducted in the '90s found that black patients had higher mortality in seven out of eight procedures surveyed. But why is that so? At the time, the researchers suggested that the black patients were admitted to hospitals that had higher mortality rates to begin with.

Recently, researchers at the University of Michigan sought a more-rounded answer to the problem. Their results, published in the journal Health Affairs, highlights a frustrating contradiction.

While black patients live closer to high-quality facilities, they are still more likely to get care in low-quality facilities. This is true even for black patients who live within five miles of a good hospital. And the more segregation there is in a given area, the more this is true. "Black patients living in regions with high degrees of racial segregation were even more likely "¦ to undergo surgery in low-quality hospitals."

It's hard to pinpoint why this is the case, but the authors point to the historic hallmarks of segregation. "The findings from this and earlier studies suggest that separate and unequal hospitalization patterns exist for a broad range of medical services," they write.

Here are a few more conclusions:

In regions with low degrees of segregation, blacks and whites were equally likely to undergo surgery in low-quality hospitals."¦

Black patients in need of major surgery may feel unwelcome in hospitals that treat a majority of white patients. Previous studies have found that racial concordance is more important for blacks than for whites in making health care decisions....

"¦ there is still a high degree of segregation in primary care, with most black patients served by a relatively small number of lower-quality physicians"¦. Blacks living in segregated regions may have less access to high-quality specialists.

As for policy solutions, two are suggested: add programs to direct black patients to high-quality hospitals, or improve the system they already find themselves in.