Black, Poor Medicare Patients Get Worse Care : Hospitals: More affluent elderly patients received better treatment, RAND study finds. But higher-quality teaching facilities minimized some shortcomings.

Adding to the evidence showing that race and income may determine the quality of health care Americans receive, a new study shows that black and poor patients with Medicare cards receive worse hospital care than other acutely ill elderly patients.

The study, to be published today in the Journal of the American Medical Assn., analyzed nearly 10,000 patients’ records at 297 hospitals in five states. The researchers at RAND, the Santa Monica think tank, found that the black and low-income elderly people fared worse than other Medicare patients whether they were treated at small rural hospitals or urban teaching hospitals.

Only 47% of the black and poor Medicare patients considered to be seriously ill when they were admitted were put into intensive care units, compared to 70% of the more affluent Medicare patients, the study found.

The researchers also said that nurses checked more frequently for breathing difficulties in new pneumonia patients who were affluent than those who were poor and black, and that doctors were less likely to find out what kinds of medicines the poor and black patients were using before hospitalization.

Among the other findings of the study, the researchers said that 19% of black and poor patients were discharged from hospitals in unstable condition, meaning they were still suffering from at least one serious health problem, compared to 14% of the rest of the group. At the same time, the poorer care received by black and low-income patients tended to be minimized because they were nearly twice as likely to be treated at higher-quality urban teaching hospitals.

The researchers said these teaching hospitals, usually located in urban centers, were so extraordinary that they often compensated for the poorer quality of care given to the patients who were black or from low-income neighborhoods.

“Because these patients receive more of their care in better-quality hospitals, there are no overall differences in quality by race and poverty status,” the authors said, while taking care to note that this was not the case within individual hospitals.

The study found that death rates were about the same for all the patients surveyed. That finding runs counter to several earlier studies that found that blacks and the poor have higher mortality rates for certain diseases.

Dr. Katherine Kahn, the study’s lead author, said it was possible that her study, even though it examined 9,932 Medicare patients, may not have been broad enough to develop meaningful data on death rates.

The survey has some clear implications for national health care reform because much of the debate is being driven by a belief that giving everyone a health insurance card will solve many of the nation’s health care ills.

The study, funded by two federal health agencies, clearly shows that simply possessing a Medicare card does not create an equal health status in the nation’s hospitals.

“The message is that health reformers have to pay attention to improving the quality of care blacks and the poor receive as well as to expanding their access,” said Kahn, an internist who teaches at UCLA Medical School in addition to her research work at RAND.

Kahn said she felt that racism clearly was a contributing factor in the differences in medical care, but said that it would take a different study to explore that issue. “Doctors and nurses have to be aware of these kinds of differences,” she said. “There clearly could be stereotyping, discrimination or bias going on here.”

David Langness, a spokesman for the Hospital Council of Southern California, said the study’s findings were further evidence that color and economic status make a difference in obtaining care.

“I don’t think there is any question that color and economic status has made a difference in the past,” he said. “I think slowly the health care system has come to terms with that and is lowering the gap. Yes, we have had care that has been unequal, and yes, it is slowly becoming more equal.”

His association represents 230 health care institutions in Los Angeles, Orange, Santa Barbara, Ventura, San Bernardino and Riverside counties.

Langness said that one of the problems with today’s health system, something he hopes will be rectified if Congress and President Clinton can reach an agreement on a health reform plan, is that there is no set standard or minimum threshold for care.

The hospitals included in the study were not identified. The 297 hospitals were in 30 urban and rural areas in California, Pennsylvania, Texas, Florida and Indiana, Kahn said.

Researchers analyzed the medical records, notes, and documents filed by physicians, nurses and others--for patients who were admitted to hospitals for congestive heart failure, a heart attack, pneumonia or a stroke.