Racial differences in the elderly's use of medical procedures and diagnostic tests.
J J Escarce,
K R Epstein,
D C Colby and
J S Schwartz
Department of Medicine, University of Pennsylvania, Philadelphia.
OBJECTIVES. This study sought to examine racial differencesin the use of medical procedures and diagnostic tests by elderlyAmericans. METHODS. We used 1986 physician claims data for a5% national sample of Medicare enrollees aged 65 years and olderto study 32 procedures and tests. For each service, we calculatedthe age- and sex-adjusted rate of use by race and the correspondingWhite-Black relative risk. RESULTS. Whites were more likelythan Blacks to receive 23 services, and for many of these services,the differences in use were substantial. In contrast, Blackswere more likely than Whites to receive seven services. Whiteshad a particular advantage in access to higher-technology ornewer services. Racial differences in use persisted among elderswho had Medicaid in addition to Medicare coverage and increasedamong rural elders. CONCLUSIONS. There are pervasive racialdifferences in the use of medical services by elderly Americansthat cannot be explained by differences in the prevalence ofspecific clinical conditions. Financial barriers to care donot fully account for these findings. Race may exacerbate theimpact of other barriers to access.
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