Racial disparity, primary care, and specialty referral

Abstract

Objective: The study examines the role of primary care physicians (PCP) in reducing racial disparities in referral-sensitive admissions.

Data sources/study setting: The study examined hospital discharges of New York residents in the age group 20 to 64 hospitalized either in New York or in any of three contiguous states -- New Jersey, Pennsylvania, or Connecticut -- using complete discharge files for the four states in 1995. The discharge data were linked to the Area Resource File and the American Hospital Association's survey files for 1995.

Study design: The study used multivariate logistic models to compare the effect of PCP supply on referral-sensitive (discretionary) admissions versus marker admissions (urgent, in sensitive to primary care) or whites, blacks, and Hispanics.

Principal findings: Compared with marker admissions, an increased PCP density in an area was associated with a higher probability of black admissions than white admissions for referral-sensitive procedures.

Conclusions: Our analysis suggests that the supply of primary care may be important for admissions for referral-sensitive procedures. Nonwhites, especially blacks, may have greater access to these procedures through increased PCP supply. Increased PCP density may significantly narrow the racial disparity in specialty referrals and improve the referral process for these procedures for nonwhites.