| Physicians Treating More Minority Patients Earn Less
Primary care physicians treating a disproportionate
share of black and Latino patients typically earn less, see more
patients, provide more charity care, treat more Medicaid patients and
receive lower private insurance payments, according to a national study
funded by the Commonwealth Fund.
These same physicians also reported more problems
providing high-quality care, ranging from inadequate time with their
patients to difficulty obtaining specialty care.
Conducted by researchers at the Center for Studying
Health System Change (HSC), the study sheds new light on the pervasive
racial and ethnic health disparities in the United States by looking
beyond individual patient characteristics to community and physician
practice resources.
The study also examined how higher Medicaid payments
might help physicians treating mostly minority patients provide
high-quality care and reduce racial and ethnic disparities.
"The findings indicate that the lower resources flowing
to physicians treating more minority patients are associated with
racial and ethnic disparities," said HSC Senior Researcher James D.
Reschovsky, coauthor of the study with HSC Senior Researcher Dr. Ann S.
O’Malley.
"Raising Medicaid payment rates, along with efforts to
increase insurance coverage or otherwise increase resources flowing to
physicians treating low-income and minority patients, could reduce
disparities," Reschovsky said.
"The findings indicate that physicians who treat mostly
minorities face challenges in delivering high-quality care. However, it
also points to solutions that can reduce racial and ethnic disparities
while improving healthcare access, quality and efficiency for
everyone," said Commonwealth Fund Assistant Vice President Dr. Anne C.
Beal. "In addition to increasing Medicaid payment levels, other efforts
such as quality reporting and financial incentives for improving care,
particularly through Medicaid, could also reduce disparities and help
move the U.S. toward a high performance health system."
The researchers first identified physicians in low-,
medium- and high-minority practices — those whose patient panels
were less than 30 percent, 30-70 percent, and greater than 70 percent
black or Latino, respectively.
About 52 percent of primary care physicians reported
having patient panels with less than 30 percent minorities, 36 percent
reported 30-70 percent of their patients were minorities, and 12
percent reported minorities constituted more than 70 percent of their
patients, confirming previous research showing that relatively small
numbers of physicians treat a disproportionately large share of
minority patients.
The study also confirmed previous research showing
well-established associations among greater minority presence, less
insurance coverage and lower incomes.
In 2004-05, physicians in high-minority practices were
located in areas with lower median incomes and higher uninsurance
rates, according to the study.
Moreover, physicians in high-minority practices received
more than a third of their practice revenue from Medicaid, compared
with 13 percent for physicians in low-minority practices.
The study also found that 35 percent of physicians in
high-minority practices reported patients’ inability to pay was a
major barrier to providing high-quality care, compared with 23 percent
of physicians inlow-minority practices.
The study was published as a Web Exclusive in the journal Health Affairs.
Address: Center for Studying Health System Change, 600 Maryland Ave. SW, #550, Washington DC 20024; 202.484.5261, www.hschange.org.
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