Heart disease in black and white

Article Abstract:

Racial differences may affect various aspects of health care despite legislation to ban segregation and discrimination against black Americans. A research study found that the black people were more likely to have out-of-hospital cardiac arrest than were white people. Black patients were also less likely to survive cardiac arrest regardless of factors such as age and sex. These differences may be caused by poor access to primary medical care in black communities. Another research study found that black veterans with cardiovascular disease were less likely to have invasive cardiovascular procedures, including angiography, angioplasty and bypass-graft surgery. Racial and social factors may affect physicians' attitudes towards different patients. They may also affect physician-patient communication. Efforts should be made to increase access to medical care in black communities and improve physician-patient communication.

Editorial

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Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system

Article Abstract:

Black patients may be less likely to have invasive cardiovascular procedures than white patients. Racial differences in the use of these procedures may be caused by different social and clinical factors. Among 428,300 veterans with cardiovascular disease or chest pain who were discharged from a Veteran Affairs hospital between 1987 and 1991, 74,570 were black and 353,730 were white. Black veterans were less likely to have cardiac catheterization and angioplasty than white veterans. They were also less likely to have coronary bypass surgery. The same types of differences were found when comparing black and white veterans with a limited income.

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Paying more fairly for Medicare capitated care

Article Abstract:

Medicare payments based on risk adjustment may be difficult to implement but should be more fair than the previous system. Risk adjustment means that the federal government will pay more money to a managed care plan to care for sicker patients than for healthy patients. The difficulty is how to measure risk. For hospital patients, the final diagnosis can be used to determine the payment. However, payments for outpatient care will require doctors to painstakingly record all aspects of the patient's condition. Nevertheless, risk adjustment is a laudable goal and should be implemented.

Analysis, Risk assessment, Finance, Managed care plans (Medical care), Medicare

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