New Studies: Outcomes for Minority Patients Linked to Source of Care; Costs Affect Access to Health Insurance at Small Firms

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<p>Two Commonwealth Fund-supported studies in the new issue of<em> Inquiry</em> explore major issues in the health care system. </p>
<p>One<a href="/publications/journal-article/2009/nov/racial-and-ethnic-disparities-use-high-volume-hospitals"> new study</a> looks at the causes of racial and ethnic disparities in health care and treatment outcomes and finds evidence of at least a contributing factor: the hospitals where minority patients seek treatment. Commonwealth Fund–supported researchers led by Bradford Gray, Ph.D., a senior fellow at the Urban Institute, report that minorities in the New York City area who require surgery for cancer, cardiovascular procedures, and a number of other medical services are significantly less likely than whites to seek care at hospitals that provide a high volume of those services. It is well established that hospitals that perform a large number of a given surgery or procedure often have better patient outcomes than those that do not.</p>
<p>Among the key findings were: </p>
<li>Black patients were significantly less likely than white patients to use a high-volume hospital for 16 of the 17 services examined between 2001 and 2002. The same was true for Hispanics with regard to 15 services and for Asians with regard to 13 services.  </li>
<li>The differences were largest for cancer surgeries and cardiovascular procedures, with a more than 20-percentage-point spread, on average, between blacks and whites for 11 services. </li>
<li>Racial and ethnic differences were found not only for services for which admissions were largely unplanned, but also for those generally planned in advance. </li>
<p>The authors recommend policies that would increase the number of high-volume hospitals among the providers of a given service, such as programs limiting the number of facilities that perform common procedures, resulting in a majority of hospitals that perform a high volume of those procedures. </p>
<p>Another <a href="/publications/journal-article/2009/nov/access-health-insurance-small-establishments-what-can-we">Commonwealth Fund–supported study</a> in the new<em> Inquiry</em> found that workers employed by small businesses are less likely than those in large ones to be offered health insurance. Administrative costs are a major reason why so many smaller firms do not offer health benefits to their employees.</p>
<p>The researchers, led by the University of Minnesota’s Jean Marie Abraham, Ph.D., found that 55 percent of full-time workers at very small firms (employing three to 10 workers) were offered health insurance over the study period, compared with 90 percent of employees in firms with 100 or more workers. These employees also were less likely to be offered a retirement plan or paid vacation. Moreover, low-wage earners were less likely to be offered health insurance than high-wage earners, regardless of establishment size. </p>
<p>The authors say insurance exchanges—regulated markets that are a key part of the health reform bills being debated in Congress—could provide new standardized plan options for employers and employees, restrictions on underwriting based on health and age, and premium subsidies for small and low-wage firms. The new plans also could provide price and quality information and administer enrollment for employees. </p>