NCPA - National Center for Policy Analysis


January 3, 2008

Disparities in health outcomes between white and minority Americans is not the product of preferential treatment or less competent doctors, says Emilia Simeonova of Columbia University.

According to Simeonova, using a new dataset from the Department of Veterans Affairs:

  • Racial differences in mortality persist even when the quality of clinics and doctors is controlled for. 
  • Although doctor quality significantly influences patient outcomes, there is little evidence of sorting of minority patients into less competent doctors and this explains only 5 percent of the differences in outcomes.
  • Individual doctors are found to treat their patients similarly regardless of race.

On the patient side, says Simeonova:

  • Variation in compliance triggers a racial mortality gap.
  • Differences in patient response to treatment significantly alter survival probabilities.
  • Considerable reductions in medical costs could be achieved by convincing patients of the importance of strictly following the therapy regimen.
  • Targeting compliance patterns could reduce the black-white mortality gap by at least two-thirds.

Two directions for policy emerge from these findings, says Simeonova:

  • Significant effort is needed to improve doctors' recognition and application of recommended therapies.
  • The mortality gap could be greatly reduced by improving patients' response to therapy; interventions focused on increasing awareness in minority patients could go a long way towards eliminating disparities.

Source: Emilia Simeonova, "Doctors, Patients, and the Racial Mortality Gap: What Are the Causes?" Columbia University, November 2007.


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