Racial Differences in the Elderly's Use of Medical Procedures and Diagnostic Tests

Published in: American Journal of Public Health, v. 83, no. 7, July 1993, p. 948-954

Posted on RAND.org on December 31, 1992

by Jose J. Escarce, Kenneth R. Epstein, David C. Colby, J. Sanford Schwartz

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This study sought to examine racial differences in the use of medical procedures and diagnostic tests by elderly Americans. The authors used 1986 physician claims data for a 5% national sample of Medicare enrollees aged 65 years and older to study 32 procedures and tests. For each service, they calculated the age- and sex-adjusted rate of use by race and the corresponding White-Black relative risk. Results showed that Whites were more likely than Blacks to receive 23 services, and for many of these services, the differences in use were substantial. In contrast, Blacks were more likely than Whites to receive seven services. Whites had a particular advantage in access to higher-technology or newer services. Racial differences in use persisted among elders who had Medicaid in addition to Medicare coverage and increased among rural elders. The authors conclude that there are pervasive racial differences in the use of medical services by elderly Americans that cannot be explained by differences in the prevalence of specific clinical conditions. Financial barriers to care do not fully account for these findings. Race may exacerbate the impact of other barriers to access.

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