The study analyzes administrative data from the Medicare program (Medicare Provider Analysis and Review (MEDPAR) files) to compare differences by race in the use of 17 major procedures performed in the hospital.

In both 1986 and 1992, black beneficiaries were less likely than white beneficiaries to have received these procedures while hospitalized. The largest differences were seen for “referral-sensitive surgeries” such as percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery, total knee replacement, and total hip replacement. These differences by race suggest that there are barriers to these services. In contrast, black beneficiaries were found to have substantially higher rates than white beneficiaries in the use of four procedures performed in the hospital: amputation of part of the lower limb, surgical debridement, arteriovenostomy, and bilateral orchiectomy.

From 1986-1992, black beneficiaries were consistently less likely than whites to be hospitalized for a surgical Diagnosis Related Group (DRG), with the black to white ratio ranging from 0.82 to 0.86.
      • The three therapeutic cardiac or vascular procedures (PTCA, CABG surgery, and carotid endarterectomy) and the diagnostic procedure (cardiac catheterization) were performed at a substantially lower rates for black beneficiaries compared with white beneficiaries in both 1986 and 1992. In both 1986 and 1992, the 30-day post-admission mortality rates following the three therapeutic procedures were consistently higher for black beneficiaries compared with whites.
      • In both 1986 and 1992, seven orthopedic and back procedures (reduction of fracture of femur, other arthroplasty of hip, total knee replacement, total hip replacement, laminectomy, excision of disc, and spinal fusion) were performed at substantially lower rates for black beneficiaries compared with white beneficiaries. Except for reduction of fracture of the femur and other arthroplasty of the hip, the 30-day post-admission mortality rates in 1992 for the other five procedures were greater for black beneficiaries compared with whites.
      • For six other procedures frequently performed (prostatectomy, open cholecystectomy, repair of inguinal hernia, mastectomy, hysterectomy, and appendectomy): In 1992 the ratio of procedure rate for black beneficiaries to that for white beneficiaries ranged from 0.97 for prostatectomy to 0.60 for hysterectomy. Except for mastectomy in 1986, the 30-day postadmission mortality rates following the seven procedures were greater for black beneficiaries compared with whites in both 1986 and 1992.
      • Black beneficiaries were more likely to be hospitalized for the following non-elective procedures compared with white beneficiaries: amputation of part of the lower limb, excisional debridement, arteriovenostomy, and bilateral orchiectomy.

Possible explanations for the findings include (1) financial disincentives may exist among black Medicare beneficiaries; (2) blacks are less likely to receive care from private physicians and are more likely to receive care from a variety of sources, which could result in delays in the management of the patient of the patient and increases in the time before surgical intervention is required; (3) patient preferences, as well as provider opinion and selection, may differ by race.

Potential explanations for higher rates for the four non-elective procedures (which may often be avoided by delayed by comprehensive and continuous medical care) were also discussed. “Black persons may be more likely to receive procedures that reflect delayed diagnosis or initial treatment, poor or infrequent medical care, or severe illness for which management of diabetes or hypertension has failed …The large differences by race in Medicare procedure rates underscore the importance of developing better information on appropriateness, outcomes, and effectiveness of treatments, as well as the importance of developing more information about differences in disease prevalence and the need for care by racial and other subgroups in our population.”