Universal Healthcare May Remove Post-Operative Racial Disparities

Privately insured African Americans more likely to experience post-operative complications.

Researchers recently found that a universally-insured health system may be able to eliminate racial disparities among patients after surgery.

In a study published by Annals of Surgery, researchers found no differences in post-operative complications or morality between African American and White patients in a universally-insured military health system. The researchers did, however, find discrepancies when uninsured or Medicaid-insured patients were treated in a civilian setting.

“To our knowledge, the effect of universal health insurance on reducing surgical disparities for African Americans had not been examined empirically prior to this study,” said lead study author Andrew Schoenfeld, MD, MSc.

Researchers analyzed claims information for 502,345 patients from the California State Inpatient Database, and claims information for an additional 129,212 patients from the Department of Defense’s Tricare system.

Tricare provides insurance for more than 8 million US military members and their families, both past and present. All service members are offered the insurance regardless of income or capacity to work.

Researchers believe that Tricare may accurately represent a universal healthcare system. Patients were included if they were African American or White, and had 1 major surgical intervention that was considered either urgent or elective.

Researchers found that privately insured African Americans with private insurance had a 20% increased risk of experiencing complications compared with their White counterparts, according to the study. Privately insured African Americans had a 30% increased risk of being readmitted, and had longer hospital stays, as well.

Researchers also found that uninsured and Medicaid-insured African Americans had a fourfold increased risk of dying. The rates of complication and readmission were twice as high compared with privately insured Whites.

Uninsured and Medicaid-insured African Americans also had hospital stays that were 12 hours longer than privately insured whites. However, researchers did not find these disparities among African Americans treated in a Tricare direct care setting.

These findings suggest that universal insurance may eliminate racial disparities, according to the study.

“It's heartening to see that healthcare disparities were virtually non-existent in the Tricare direct care setting, a unique environment where the color of one's uniform likely outshines the color of one's skin,” said senior study author Adil Haider, MD, MPH.