racial inequalities persist in the United States


Among the population covered by Medicare in the United States from 2005 to 2020, black women had less access to new mammography technologies than white women, even when having their mammograms at the same facility. A study published in the Revue Radiology on more than 4 million examinations confirms this, even if these disparities tend to fade.

Black American women are 40% more likely than white women to die from breast cancer, even though the cancer incidence rate for black and white women is about the same.

Medicaid reimbursement rates less favorable to technological advances

The reason for this inequality? Technological advances in the early detection of breast cancer are not accessible in the same way for one or the other. In the United States, the social Medicare program can facilitate access to new breast cancer screening technologies in underserved areas and reduce the duration of racial and regional disparities in this field. But a recent study published in the Journal Radiology shows that a Medicare reimbursement is 1.2 to 1.8 times lower than that of private insurers.

In an increasingly competitive healthcare environment, the Centers for Medicare and Medicaid Services (CMS) cannot expect medical providers to ignore these competitive forces and engage in equity efforts. disregarding economic consequences by locating technology and services where reimbursement is low notes study co-author Prof. Eric W. Christensen, senior researcher in health economics for the Harvey L. Neiman Health Policy Institute and adjunct professor of health services management at the University of Minnesota. in Minneapolis.

Lower ratios of black women than white women for access to digital mammography in 2005

This study, conducted in collaboration with the Radiology Health Equity Coalition (RHEC), sets out to examine the relationship between race and the use of new mammography technologies among the women under review. ” RHEC plays an indispensable role in research to address health disparitiescontinues the co-author of the study, Pr Jinel Scott, Associate Professor of Clinical Radiology in the Department of Radiology at the State University of New York Downstate Health Sciences University. Our article nicely describes the goal of RHEC to move from primarily descriptive analyzes to predictive and ultimately prescriptive approaches to addressing inequities in health care delivery. “.

The researchers therefore conducted a retrospective study of women aged 40 to 89 with fee-for-service health insurance who had mammograms between January 2005 and December 2020, using a 5% sample. of all Medicare fee-for-service recipients. They analyzed 4,028,696 requests for institutional mammography for women (mean age 72). Within an establishment, the odds ratio (OR) of black women on whom a digital mammography was performed rather than an examination using the screen-film couple in 2005 was 0.80 compared to white women. These differences persisted through 2009. Compared to white women, use of tomosynthesis within an institution was less likely for black women from 2015 to 2020 (OR: 0.84).

Differences within an establishment as well as between establishments

The study found evidence of racial differences in the years following the introduction of new mammography technology. These disparities include both differences within an institution and differences between comparable institutions. According to Dr. Christensen, the promotion of reimbursement policies and favorable incentives can reduce these differences if kept pace with changing technologies.

Current reimbursement contributes to inequity because localizing new technologies in facilities that treat patients with public insurance, Medicare and Medicaid, is not economically viablehe continues. CMS can create economic incentives to reduce disparities through reimbursement comparable to that of private payers, or that more directly incentivizes the adoption of newer technologies in underserved communities. »

The researchers state that organizations have a responsibility to be equitable in the delivery of care. The fact that racial differences for digital mammography have been transitory and have lessened as the new technology has become universal, confirms the real potential of such policy changes to lessen the transitory disparities associated with technological advancements.

RHEC includes RSNA, ACR, American Board of Radiology, American Medical Association Section Council on Radiology, Association of University Radiologists, National Medical Association Section on Radiology and Radiation Oncology, Society of Chairs of Academic Radiology Departments, Society of Interventional Radiologists, Society of Nuclear Medicine and Molecular Imaging, and American Association of Medical Physicists.

Bruno Benque with RSNA

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