The Gist Black Medicare patients are more likely than white ones to be treated by a primary care doctor who can't provide consistently high-quality care. So finds a study by researchers at New York's Memorial Sloan-Kettering Cancer Center and the Center for Studying Health System Change in the Aug. 5 New England Journal of Medicine. Researchers called the difference so striking that it suggests the existence of two disparate health care systems.

The Details Analyzing nationwide data from 4,355 doctors who had 150,391 visits with Medicare beneficiaries in 2001, researchers found that 80 percent of black patients were treated by only 22 percent of doctors. Those doctors were less likely than the other 78 percent to be board-certified in their primary specialty and more likely to have difficulty getting their patients access to high-quality imaging facilities, hospitals, specialists and ancillary services.

What Else? Lead author Peter B. Bach, a researcher at Memorial Sloan-Kettering, theorized that hospitals are more likely to be overcrowded in neighborhoods where black patients get their care, and the physicians may not have admitting privileges to hospitals in other areas. Fewer specialists and high-quality imaging facilities in their home neighborhood also means less access to services, Bach said. Earlier studies of his have blamed lower survival rates among black cancer patients at least partly on poorer health care they received before diagnosis.

What Now? While prior research has often focused on whether racism among doctors is responsible for disparities in health care, Bach says this study shows that other factors affecting outcomes must be considered.

-- Suz Redfearn