"The results of this analysis suggest that aggregate characteristics of populations at the community and practice levels have implications for the care available to patients," state the authors of an article published on April 22, 2008, in Health Affairs Web Exclusives. Although
there is broad consensus that racial and ethnic differences in the quality of health care exist, there is much disagreement about the root causes. This analysis explores whether physicians whose patient panels (the set of patients they treat) consist of a disproportionate percentage of minorities report more difficulties obtaining services for their patients and delivering high-quality care than those treating fewer minority patients. In addition, the authors explore whether
increasing resources flowing to high-minority practices, specifically by increasing Medicaid reimbursement amounts, might improve physicians' ability to provide high-quality care.

The authors found that

* About 52% of PCPs reported having patient panels with less than 30% minorities (low-minority practices), 36% reported 30-70% minority patients (medium-minority practices), and 12% reported more than 70% minority patients (high-minority practices).

* Physicians in high-minority practices received more than a third of their practice revenue from Medicaid -- more than twice that of physicians in low-minority practices.

* Compared to physicians in low- and medium-minority practices, those in high-minority practices were more likely to report quality-related difficulties, such as inability to provide referrals to high-quality specialists, inability to spend adequate time with patients, and other problems.

* More than a quarter of physicians in high-minority practices disagreed that it was possible to provide high-quality care to all patients, compared with 16% of physicians in low-minority practices.

* According to simulated responses, if Medicaid fees were raised to Medicare levels, physicians' reports of difficulties providing care for their patients would often decline.

The authors conclude that "in addition to raising payment rates for the treatment of Medicaid patients, efforts to increase insurance coverage or otherwise increase resources flowing to physicians who serve low-income and minority populations would implicitly reduce disparities."

Reschovy JD, O’Malley AS. 2008. Do primary care physicians treating minority patients report problems delivering high-quality care? Health Affairs 26(3):w222-w231. Abstract available online.