摘要：Objectives. We used 1997 Medicare data to replicate an earlier study that used data from 1986 to examine racial differences in usage of specific medical procedures or tests among elderly persons. Methods. We used 1997 physician claims data to obtain a random sample of 5% of Medicare beneficiaries aged 65 years and older. We used this sample to study 30 procedures and tests that were analyzed in the 1986 study, as well as several new procedures that became more widely used in the early 1990s. Results. Racial differences remain in the rates of use of these procedures; in general, Blacks have lower rates of use than do Whites. Between 1986 and 1997, the ratio of White to Black use moved in favor of Blacks for all but 4 of the established procedures studied. Conclusions. The White–Black gap in health care use under Medicare is narrowing. Racial and ethnic disparities in health care use in the United States are pervasive and widely acknowledged. 1, 2 The Institute of Medicine’s recently released Unequal Treatment 2 contains an appendix with 600 articles documenting disparities. Although empirical research on disparities has burgeoned in the past decade, important gaps remain in the literature. The Institute’s report concludes that little is known about the mechanisms that generate disparities from within the clinical encounter; much less is known about disparities for non-Black racial or ethnic minorities. Also, because most research on disparities features data at a single point in time, we know little about whether disparities between Blacks and Whites are growing or shrinking. Researchers have speculated on how changes in the organization and financing of health care, particularly the growth of managed care, may influence the magnitude of racial and ethnic disparities in treatment, but data documenting trends in disparities are scarce. In a recent review, Gornick 3 concludes that racial disparities in Medicare “tend to persist over time” but the most recent data cited on surgical procedures were for 1992. Data from the Medicare program offer an opportunity to monitor trends over time. Medicare records census-like information about race and ethnicity in the enrollment process, and this information is reliable for Blacks and Whites. 4 Medicare provides health insurance to virtually every US adult older than 65 years, about 40 million people in total, and is the nation’s largest single payer of hospital care. In 1997, 87.0% of Medicare beneficiaries were White, 8.4% were Black, and 2.3% were Hispanic, with the balance distributed among persons of Asian/Pacific Islander, American Indian/Alaska Native, Other, and Unknown race/ethnicity. 4 Enrollment and health care use data in the program have been stable for many years. Some of the more notable studies documenting health care disparities have used Medicare data. 5– 7 In the report by Escarce et al. that served as a model for our study, 8 Medicare data for 1986 were used to study differences in health care use between Blacks and Whites for 32 selected procedures and tests. For most services, and particularly for newer or high-technology services, Escarce et al. found that Whites had age- and gender-adjusted rates of use that exceeded those of Blacks. Our study replicates the Medicare 1986 analysis with data from 1997. We used the same data files and examined the same procedures, defined in the same way, as did the 1986 study; we also examined several newer procedures that became widely used in the early 1990s. For purposes of comparison, we adjusted the data by means of the same methods used in the earlier article, thereby permitting direct comparison of rates over time.
