In response to a study showing that black patients are less likely than white patients to be referred for kidney transplantation, Medicare is taking steps to ensure that all patients with renal failure will be evaluated for transplantation regardless of their race or ethnicity.
"Medicare rules require that all patients with kidney failure be evaluated and informed about transplantation," said Health Care Financing Administration (HCFA) administrator Nancy-Ann DeParle. "We want to be sure this is happening and be sure there is equal opportunity for transplantation when needed, regardless of a patient's race."
HCFA made its announcement as John Z. Ayanian, MD, and colleagues at Harvard Medical School reported on racial disparities in transplantation on November 25 in The New England Journal of Medicine. While their study reiterated the well-documented racial disparity that exists in access to kidney transplantation, they also found that — in contrast to conjecture — the difference is not due to patient preference (1999;341:1661-1669).
"To improve access to treatment options, health care providers and policy makers need to know the factors creating barriers to care. This study begins to address this need by tackling the hypothesis that patient preference is a root cause of the racial differences we see in treatment options selected," Dr. Ayanian said.
The authors' findings were based on interviews of 721 black patients and 671 white patients with endstage renal disease. While black patients were slightly less likely than white patients to want a transplant, blacks were much less likely than whites to have been referred to a transplantation center for evaluation. About 76% of black women, 79% of white women, 81% of black men, and 86% of white men wanted a transplant. However, referrals for evaluation for a transplant were made for 50% of black women, 71% of white women, 54% of black men, and 76% of white men.
For Your Information:
statement from HCFA
www.hhs.gov/news/press/1999pres/991124a.htmlstatement from Harvard
www.hms.harvard.edu/news/releases/1199ayanian.html
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