Region Affects Health Care Quality

Researchers at Dartmouth University have found striking regional differences in quality of health care. In addition, within any given region, black people are less likely to receive the appropriate health care than white people.

But region was the strongest factor that affected quality of health care. From the article:

For instance, the widest racial gaps in mammogram rates within a state were in California and Illinois, with a difference of 12 percentage points between the white rate and the black rate. But the country’s lowest rate for blacks – 48 percent in California – was 24 percentage points below the highest rate – 72 percent in Massachusetts. The statistics were for women ages 65 to 69 who received screening in 2004 or 2005.

In all but two states, black diabetics were less likely than whites to receive annual hemoglobin testing. But blacks in Colorado (66 percent) were far less likely to be screened than those in Massachusetts (88 percent).

What causes these differences? The researchers suggest that multiple factors are at work:

Such variations may be partly explained by regional differences in education and poverty levels, but researchers increasingly believe that variations in medical practice and spending also are factors.

The most extreme disparities, as the article notes, concern some important and even life-altering procedures. For instance, people in Louisiana, Mississippi and South Carolina are much more likely to have their legs amputated (usually as a result of diabetes or vascular disease) than those in Colorado or Nevada, and black people in those regions are much more likely to undergo amputation than whites. Also, access to mammograms sharply varies according to region.

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