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Confronting inequities in medical care

The fact that Erie County spends a lot more per person taking care of white Medicaid patients than patients of color is nothing new in the world of health care. Glaring racial disparities have been as much a part of the medical system as Band-Aids.

What’s new is the county’s willingness to dig into the numbers to find out why. So is the prospect that increasingly sophisticated data collection under the Affordable Care Act – the very act Republicans want to kill – will, if not eliminate such disparities, make them too obvious to continue ignoring.

The differences in Erie County – unearthed during an analysis of the county’s $1.5 billion Medicaid program – are stark: The program spends $8,527 per white recipient, compared with $5,220 per black patient and $4,749 per Hispanic.

To his credit, County Executive Mark Poloncarz zeroed in on the disparities and ordered the county’s Medicaid inspector general to dig deeper to find out the reasons by year’s end “because Medicaid is supposed to be a fair system.”

If he can achieve medical fairness, he would be the first.

“There’s always been a two-tiered system” in health care, said Dr. Raul Vazquez, outgoing president of the local chapter of the National Medical Association.

He’s right: The disparities exist even when whites and patients of color have equal insurance and access to doctors.

For instance, a 2011 study of women who had Department of Defense insurance found that blacks were less likely than whites to get aggressive treatment such as chemo or hormone therapy when combating breast cancer.

Similarly, a series of studies published in the New England Journal of Medicine in 2005 found that – again, after controlling for insurance – blacks were less likely than whites to get expensive treatments such as heart or back surgery or joint replacements.

And as far back as 1989, the American Medical Association reported that black men were only half as likely as whites to undergo angioplasty and one-third as likely to undergo heart bypass surgery. In that context, the Erie County findings are shockingly unsurprising. The only surprise is that in a quarter-century, the medical community still hasn’t fixed the problem.

Part of it undoubtedly results from lingering biases – conscious or unconscious – that result in some patients being deemed more worthy of expensive treatments than others.

Part of it also could result from cultural issues of familiarity and trust.

“I know what our community needs. I know what Puerto Ricans and blacks do,” said Vazquez, whose wife is African-American. “If you don’t know the culture, it’s hard to treat them.”

To that end, the Affordable Care Act’s support of efforts such as the Greater Buffalo United Accountable Healthcare Network – which includes Vazquez’s Urban Family Practice – helps by funding care in communities of color, as well as more data collection.

Part of Erie County’s disparity also may result from more whites having transferred assets to take advantage of Medicaid nursing home coverage.

Or it could be all of the above.

Whatever the reason turns out to be, Poloncarz is eliminating “we didn’t know” as an excuse. That’s the first step in pursuing medical equity.