African American Surgical Patients Benefit in Universally Insured Health System

African Americans treated in civilian settings, either uninsured or on Medicaid, however, experienced substantially higher odds of mortality, complications and readmission after surgery, compared to White patients.

A new research looking at claims data from more than 630,000 patients found no significant differences in post-operative complications or mortality between African American and White patients, who were treated in a universally insured military health system.

‘African Americans with private insurance had approximately 20 percent higher odds of experiencing complications, compared to privately insured White patients.’

These findings suggest universal insurance could mitigate disparities. The study, "Association between race and post-operative outcomes in a universally insured population versus patients in the State of California," was published online in Annals of Surgery.

Researchers at the Uniformed Services University of the Health Sciences (USU) led by principal investigator of the Comparative Effectiveness and Provider Induced Demand Collaboration (EPIC) Dr. Tracey Pérez Koehlmoos, PhD, MHA associate professor of Preventive Medicine and Biostatistics at the F. Edward Hébert School of Medicine, in collaboration with Brigham and Women's Hospital, looked at claims information for more than 502,000 patients from the California State Inpatient Database (2007-2011), and more than 129,000 patients from the Department of Defense's (DoD) health insurance (TRICARE) system (2006-2010).

TRICARE is one of the nation's largest health insurers, providing care to more than 8 million American military service members, retirees and their dependents. TRICARE is available to beneficiaries regardless of social class, occupational status or capacity to work. This may better represent a universal healthcare initiative, as compared to looking at data from patients insured through Medicare or other private plans.

Patients reviewed in the study were over the age of 18 and received one of 12 surgical procedures inclusive of cardiothoracic surgery (coronary artery bypass grafting), general surgery (appendectomy, colectomy, esophagectomy inguinal hernia repair), orthopaedics (total knee replacement, total hip replacement, hip fracture repair), urology (nephrectomy, transurethral resect ion of the prostate, radical cystectomy), and neurosurgery (lumbar spine surgery). These procedures are representative of the types of major surgical interventions performed across these disciplines. Patients were also included in the study if they were African American (non-Hispanic black) or White (non-Hispanic White).

According to the study, African Americans with private insurance had approximately 20 percent higher odds of experiencing complications, compared to privately insured White patients. They also experienced approximately 30 percent higher odds of being readmitted and could expect longer hospital stays - more than 12 hours longer than privately insured White patients. Their odds of experiencing complications and readmission were almost twice as high compared to privately insured White patients. The risk for dying among uninsured African Americans and those on Medicaid, was about fourfold.

These disparities, however, were absent among African Americans treated directly within DoD hospitals, also known as the TRICARE direct care setting. "What we've found is that, in a more equitable health system, like the Military Health System, paired with universal insurance, racial disparities could potentially be eliminated. The MHS is an example for the nation," Dr. Koehlmoos said.

Source: Newswise