Racial disparities in access to long-term care: The illusive pursuit of equity
Racial disparities in access to long-term care: The illusive pursuit of equity
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DOI：
10.1215/03616878-2008-022
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发表时间：
2008-10-01
影响因子：
4.2
通讯作者：
Mor, Vincent
中科院分区：
文献类型：
--
作者：
Smith, David Barton;Feng, Zhanlian;Mor, Vincent
虽然疗养院在实施联邦医疗保险计划时不受民权执法的影响，在向少数族裔提供类似机会方面落后于卫生部门的其他部门，但它们是目前报告要求有可能全面评估使用情况和护理质量的种族差异的唯一提供者。我们发现，2000年美国非裔美国人对养老院的使用率比白人高出14%。2000年，非洲裔美国人对养老院的相对使用量最大的是南部和西部。非裔美国人和高加索人的平均疗养院病例混合敏锐度基本相同，这表明支付激励措施的转变已经消除了选择性接纳容易护理的私人付费(主要是白人)患者，并帮助推动了这部分人口的私人付费家庭护理和辅助生活的增长。虽然这些激励措施的转变帮助增加了非裔美国人对养老院的使用，但非洲裔美国人使用的养老院的高度隔离和质量差异仍然存在。使用平等是衡量在确保治疗公平方面取得进展的一个虚假基准。
While nursing homes were insulated from civil-rights enforcement at the time of the implementation of the Medicare program and lagged behind other parts of the health sector in providing comparable access to minorities, they are the only providers for which current reporting requirements make it possible to fully assess racial disparities in use and quality of care. We find that African Americans' use of nursing homes in 2000 in the United States was 14 percent higher than Caucasians' use. The largest relative African American use of nursing homes in 2000 took place in the South and West. Average nursing-home case-mix acuity for African Americans and Caucasians were essentially identical, suggesting that shifts in payment incentives have eliminated the selective admission of easy-care private-pay (predominantly Caucasian) patients and helped fuel the growth of private pay home care and assisted living for this segment of the population. While these shifts in incentives helped increase the use of nursing homes by African Americans, a high degree of segregation and disparity in the quality of the nursing homes used by African Americans persists. Parity in use is an illusive benchmark for measuring progress in assuring equity in treatment.