new research about racial health disparities in nyc

In May, the Community Service Society (CSS) published the first report (seond link from bottom in sidebar) of a two part series looking at health care in New York. CSS is an advocacy group for the poor of New York, but this first report focused on the health care quality and its variance across racial groups. While the data is no longer new, I came across it relatively recently and think it’s worth blogging.

The report was based on data gathered from the Quality Assurance Reporting Requirement (QARR). This program enables the city to offer pay for performance incentives to various health care plans using the data generated. The study’s authors requested the data logged about all Medicaid enrollees over the course of three years. However, the information they received from the Department of Health and Human Services was primarily from 2007. The study’s authors felt that using data from only publicly insured patients would help control for differences in health outcomes based on wealth.

One of the report’s more depressing findings was that, “On a number of key health indicators, African Americans in New York experience disproportionately worse outcomes than other groups.” The report went to say that African Americans had statistically worse outcomes than the aggregate of other groups on 10 of the 12 measured outcomes

The outcomes measured by the study were divided into two categories: preventative care and management, and management of diabetes. The outcomes categorized as preventative care and management included: mammography, childhood immunizations, childhood dental visits, child asthma, and adult asthma. The management of diabetes outcomes were: HbAIc testing, poor HbA1c control, lipid profile, lipids controlled, blood pressure controlled, dilated eye exam (diabetics must have one dilated eye exam per year to screen for diabetic retinopathy), and nephropathy screening. Of these, the only two outcomes for which African Americans had similar outcomes to the population as a whole were childhood immunizations and nephropathy screening.

Other analyzed groups included: Caucasians, Asian/Pacific Islander, and Latino. Whites performed statistically better than the aggregate at childhood dental visits, child and adult asthma, poor HbA1c control, and blood pressure. They had worse outcomes in childhood immunizations, mammography, and nephropathy screening. Asian/Pacific Islanders had the better outcomes than the aggregate in every outcome except for nephropathy screening and childhood immunization. Latinos did better than the aggregate at childhood immunizations, childhood dental visits, mammography, and lipid profile and lipid control. They performed similarly to the aggregate for all other outcomes.

The report concluded with a few policy recommendations. The first was that the state monitor and report on disparities in health care among publicly insured individuals, breaking the data down by plan. The second was that the state use its purchasing power to promote health equity by using additional pay-for-performance initiatives targeted to reduce racial disparities in health care as well as and more aggressive monitoring. Elisabeth R. Benjamin, one of the authors of the study, told the New York Times, “Our position is that the health system is failing African-American folks, and we know that pay-for-performance works.” She went on to say, “We’re saying let’s use it [pay for performance] with a race lens, which has never been done in the country…We think this is one of the areas where New York State can take a lead in the country.”

The second report in the two part series, which I hope to read and write about later, analyzes involuntary disenrollments from public insurance plans.