Quantity over quality? Minorities shown to get an excess of ineffective care

hospital hallway
From Kaiser Health News: Researchers looked at 11 services that medical groups have said are often unnecessary and found that Hispanics and blacks got them at higher rates than whites

This article originally appeared in Kaiser Health News.

Minority patients face a double whammy: Not only are they more likely to miss out on effective medical treatments than white patients, but, according to a new study, they’re also more likely to receive an abundance of ineffective services.

The study, published in the June issue of Health Affairs, examined 11 medical services identified as “low value” by the ABIM Foundation’s Choosing Wisely initiative. That program pinpoints unnecessary, overused medical tests and treatments in an effort to reduce waste and avoid needless risk in the healthcare system.

Researchers analyzed Medicare administrative data from 2006 to 2011 for beneficiaries in the traditional Medicare program who were 65 or older among black, white and Hispanic groups.

Among the low-value services that researchers studied, black and Hispanic beneficiaries were significantly more likely to receive many of them than were whites. For example, 17.4% of black patients and 12.8 % of Hispanics with advanced dementia received feeding tubes during the study period, compared with just 4.6% of white patients. Similarly, while 14.9% of white patients received cardiac testing before cataract surgery, the figures for blacks and Hispanics were higher, 17.3 and 20.5%, respectively.

Black and Hispanic patients were more likely to receive other ineffective services as well, including antipsychotics for those with dementia, imaging for an enlarged prostate and bone-density testing. In a couple of instances, white patients were more likely to receive unnecessary services, including imaging for low-back pain, cervical cancer screening and vitamin D screening.

A significant body of research has shown that U.S. minorities tend to receive fewer medical services that are considered effective, such as flu shots or aspirin following a heart attack, said William Schpero, a Ph.D. student at Yale School of Public Health who was the study’s lead author. That disparity is typically attributed to problems with access to the healthcare system, he said.

However, visiting the doctor frequently was no guarantee of better care, the study suggested. Researchers found that greater use of the healthcare system was often associated with significantly higher rates of low-value care for many services.

“Our findings show that improving access is a necessary but not sufficient part of the policy solution,” said Schpero. “Improving quality is important as well.”