The purpose of this study was to examine whether racial differences exist in access to high-quality cardiac surgeons, under the premise that a systematic bias in access to high quality cardiac artery bypass graft (CABG) providers indicates that racial minorities are at a disadvantage even when they gain access to CABG. Quality was measured by risk-adjusted mortality rates (RAMS). Data for this study were collected from all patients in New York State discharged with a CABG diagnosis-related group in 1996.

On average, non-whites enrolled in fee-for-service plans were treated by surgeons with higher RAMS (worse care) than whites. The HMO-enrolled non-whites were also treated by surgeons with higher RAMS than whites, but this effect was not statistically significant. The latter difference is likely to be as important as the former, as the magnitude of the race effect for the HMO enrolled was higher than that for the fee-for-service enrolled (the mortality rate is 5.4% higher for surgeons treating non-white fee-for-service enrollees and 11.7% higher for surgeons
treating non-white HMO enrollees). Additionally, women were operated on by surgeons with higher RAMS than men.

The authors suggest several possible explanations for these findings. First, the racial disparities may reflect racial differences in access to information about the quality of cardiac surgeons. Cost may also be a barrier for non-whites, who tend to have lower incomes. For those with HMO insurance, the racial difference in access to high quality surgeons may reflect differences in HMO contracting practices (e.g., HMOs that enroll large numbers of non-whites might contract with lower quality surgeons).