Health Care Shabby For All

BOSTON — Startling research from the biggest study ever of U.S. health care quality suggests that Americans — rich, poor, black, white — get roughly equal treatment, but it’s woefully mediocre for all.

“This study shows that health care has equal-opportunity defects,” said Dr. Donald Berwick, who runs the nonprofit Institute for Healthcare Improvement in Cambridge, Mass.

The survey of nearly 7,000 patients, reported in today’s New England Journal of Medicine, considered only urban-area dwellers who sought treatment, but it still challenged some stereotypes: The blacks and Hispanics actually got slightly better medical treatment than whites.

While the California-based researchers acknowledged separate evidence that minorities fare worse in certain areas of expensive care and suffer more from some conditions than whites, their study found that once in treatment, minorities’ overall care appears similar to that of whites.

“It doesn’t matter who you are. It doesn’t matter whether you’re rich or poor, white or black, insured or uninsured,” said chief author Dr. Steven Asch at the Rand Health research institute in Santa Monica. “We all get equally mediocre care.”

The researchers, who included U.S. Veterans Affairs personnel, first published their findings for the general population in June 2003. They reported the breakdown by income, racial and other groupings on Thursday.

They examined medical records and phone interviews from 6,712 patients, picked at random, who visited a medical office within a two-year period in 12 metropolitan areas from Boston to Miami to Seattle. The group was not nationally representative but does convey a broad picture of the country’s health care.

The survey examined whether people got the highest standard of treatment for 439 measures ranging across common chronic and acute conditions and disease prevention. It looked at whether they got the right tests, drugs and treatments.

Overall, patients received only 55 percent of recommended steps for top-quality care — and no group did much better or worse than that.

Blacks and Hispanics as a group each got 58 percent of the best care, compared with 54 percent for whites. Those with annual household income over $50,000 got 57 percent, 4 points more than people from households with income of less than $15,000. Patients without insurance got 54 percent of recommended steps, just 1 point less than those with managed care.

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