While the Patient Protection and Affordable Care Act aims to provide better healthcare access for millions of uninsured Americans, a new study has found that some minority groups face challenges in obtaining quality healthcare for other reasons.

A study released Jan. 8 by the University of Michigan Health System showed higher mortality rates for non-white patients in cardiac procedures has been linked with the quality of the hospital where the patients receive treatment.

Researchers and doctors have known about the mortality rate disparities for a while, but how hospital quality plays into them hasn’t been as clear.

University Medical School alum Govind Rangrass, a medical resident at Washington University in St. Louis, Assistant Surgery Prof. Amir A. Ghaferi and Associate Surgery Prof. Justin Dimick conducted an observational study tracking Medicare information from 2007 to 2008, which revealed the correlation outlined in their study. However, the researchers cautioned that some of the disparity remains unexplained.

“Other studies have looked at the racial disparities and have tried to explain them by pointing to differences in the patient population — that nonwhite patients tend to be sicker or have more medical comorbidities, and that affects their outcomes,” Rangrass said. “Or they could have a lower socioeconomic background, lower education levels. One thing that hadn’t been looked at was where they went for care.”

The study followed over 173,000 patients in the Medicare database who underwent coronary artery bypass graft surgery. About eight percent of the study population was nonwhite. Results indicated that nonwhite patients had a 33 percent higher mortality rate post-surgery than whites, bearing out previously established differences.

Carmen Green, UMHS associate vice president and associate dean for health equity and inclusion, said the broad impact of inequalities like these could be quite expensive.

The social cost of healthcare inequalities — the cost hospitals must incur due to sicker populations and lost productivity — is estimated at about $1.2 trillion, according to a report from Johns Hopkins University.

In examining the link to hospital quality, the study found that the mortality rates in hospitals that treated the most nonwhite patients had the highest mortality rates of all hospitals included in the study — regardless of the race of individual patients being treated.

To improve care, Rangrass said hospitals that treat large communities of nonwhite patients need to be looked at more closely, which might be difficult in coming years since a mandate in the Affordable Care Act that penalizes underperforming hospitals.

“It’s kind of like a reverse Robin Hood effect, where now we’re going to be penalizing those hospitals that actually need the most amount of resources,” he said. “These are hospitals that have lower access to tech — they are underfunded, under resourced, they may also be lower volume centers for care, and so diverting resources from those underperforming centers, specifically places who treat larger percentages of nonwhite patients, is actually going to worsen the racial disparity.”

The study still leaves some questions unanswered and raised some new ones. Independently, hospital quality explained only 35 percent of the racial differences in mortality rates. When the data was adjusted for patient factors and socioeconomic status in addition to hospital quality, researchers were able to explain 53 percent of the racial disparities.

The study’s authors said this research is just the first step in exploring why the inequalities in mortality rate between white and nonwhite patients exist. Factors listed as potential causes for the remaining unexplained differences include regional variations in hospital quality, proximity to high-quality hospitals and segregated referral patterns.

For Green, the UMHS vice president, the real world implications of data like this is something that should first be considered on the internal level. Green cautioned that she viewed this study more as preliminary research rather than conclusive results because of the many factors that can contribute to the inequalities.

“A person like me, who’s in my position, would say ‘Hmm. Let’s take a look at ourselves,’” Green said. “Let’s look at the University of Michigan. How do we think about this? At our cardiovascular center, how do we think about making certain that one, we always put patients and family first?”

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