“This study follows in Wennberg’s tradition, using claims data to distinguish differences in medical treatment that may not be explained by differences in the underlying need and in demand for health-care services….The findings suggest that, although the aggregate black procedure rates were higher, the black utilization was weighted substantially toward lower cost procedures and services.…These matched sample results indicate considerably greater inequity than seen from the population-based comparisons…The results indicate substantially greater inequity in the South compared with the non-South. …The South/non-South disparities were most dramatic for selected cardiovascular procedures.”

“The White/Black ratios varied considerably by procedure type and cost.…Blacks and whites in our matched sample data had differential access to newer technologies. Additionally, as noted in a study by Chassin et al., for 26 procedures examined, the white-black usage disparities were significantly larger for those procedures with demonstrably less practice uniformity across geographic areas.”

“…Whatever the behavioral mechanism, providers seemed to be giving less care to matched sample black Medicare beneficiaries. A possible interpretation for the finding that white-black utilization disparities varied directly with the costliness of the procedure is that the more costly medical and surgical procedures tended to be performed by specialists, and the highest-cost procedures were performed by specialists on an inpatient basis. If blacks have greater difficulty gaining access to specialty providers, the data would tend to indicate much the same relationship.”