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Location could be behind gap in health care for blacks

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Experts have long tried to figure out why blacks receive poorer-quality health care than whites.

A study in today's New England Journal of Medicine finds that geography might be part of the problem: Doctors in largely black neighborhoods are more likely to say they have trouble providing high-quality care.

In an analysis of more than 150,000 visits by Medicare patients, researchers from Memorial Sloan-Kettering Cancer Center and the Center for Studying Health System Change found that blacks and whites mostly go to doctors with different abilities and resources:

* Doctors caring for blacks were less likely to be board-certified in a specialized area of medicine. Non-certified doctors are less likely to screen their patients for diseases, the authors wrote, and more apt to treat symptoms rather than diagnose an underlying disease.

* Doctors who treated blacks more often said they had trouble referring patients to specialists, getting diagnostic imaging tests and admitting patients to hospitals for non-emergency care.

* About 28% of visits by black patients -- compared with 19% of visits by whites -- were to doctors who said they could not consistently provide high-quality care.

''The findings paint a picture of two health systems, where physicians treating black patients appear to have less access to important clinical resources and be less well-trained,'' says Peter Bach, lead author and a pulmonologist and epidemiologist at Memorial-Sloan Kettering.

The study could help explain why blacks suffer disproportionately from many diseases, says Harold Freeman of the Center to Reduce Cancer Health Disparities at the National Cancer Institute.

The study raises many questions, Bach says. ''We don't have any way to figure out why certain doctors are practicing in certain areas,'' he says.

The study suggests discrimination may be at work, not by individual doctors but because blacks often live in poor neighborhoods with fewer resources, says Arnold Epstein of the Harvard School of Public Health, who wrote an editorial in the journal. ''In health care, integration is not complete, and separate is not equal,'' he wrote.

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