Does race matter in universal healthcare? Stroke cost and outcomes in US military health care

• Published in: Ethnicity & health Vol. 25; no. 6; pp. 888 - 896
• Main Author: Holtkamp, Matthew D
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 17.08.2020; Taylor & Francis Ltd
• Subjects: Access; African Americans; Armed forces; Civilians; Clinical outcomes; Correlation; Cost analysis; Costs; Health care; Health care expenditures; Health problems; Health services; Health status; Hospitalization; Hospitals; Inequality; Ischemia; Length of stay; Medical diagnosis; Military; Minority & ethnic groups; Mortality; Mortality/survival; Parameter identification; Patient admissions; Patients; quality and outcomes; Quality of care; Race; Race factors; Racial differences; Racial inequality; Regression analysis; Stroke; universal healthcare; United States > US; quality and outcomes; universal healthcare; Mortality/survival; military; stroke
• ISSN: 1355-7858; 1465-3419
• DOI: 10.1080/13557858.2018.1455810

Introduction: It is well documented in the US civilian healthcare system that race is correlated with different outcomes for ischemic stroke patients. That healthcare system has wide variations in access to and quality of care. In contrast, the US military healthcare system (MHS) a universal healthcare system where every member has access to the same healthcare benefits. Do racial disparities evident in the civilian healthcare system transfer to the MHS? Methods: Data was collected from the MHS Military Mart (M2) database from calendar years 2010 through 2015. All adult patients with a primary diagnosis of ischemic stroke upon discharge were reviewed. Race was compared across primary outcomes of: (1) IV tPA administration and (2) Disposition destination 'poor disposition destination or in-hospital mortality'. And secondary outcomes of: (1) Total cost of hospitalization and (2) Length of hospital stay. Relevant demographic and co-morbidities were adjusted with regression analysis. Results: A total of 3623 patients met this study's parameters. Race was identified in 2661 (73.5%) admissions. Racial composition of this patient sample was: White 1767 (48.8%), African Americans 619 (17.1%), Asian 275 (7.6%), Other or Unknown 962 (26.5%). There was no correlation between race and administration of IV tPA, poor disposition destination or in-hospital mortality. There was a correlation between African Americans and increased cost of hospitalization. This finding was correlated with costs for radiological studies but was not correlated with any increase in the length of stay. Conclusion: Racial disparities evident in the civilian healthcare system do not appear to transfer the universal healthcare system represented by the MHS. Universal healthcare mitigates racial disparities in ischemic stroke admissions.