Restricted access to care: the role of race, managed care, and type of insurance.

This article compares African American patients who entered the hospital with the same medical condition-acute myocardial infarction-to similar white patients to assess the relative contributions of insurance type and managed care to the race gap in access to three expensive invasive procedures for treating heart disease: cardiac catheterization, percutaneous transluminal coronary angioplasty (angioplasty or PTCA), and coronary artery bypass surgery (CABG). With data from the state of Maryland, we find that the races differ markedly in their insurance coverage and African Americans have significantly less access to the procedures. Type of insurance and HMO explained little of the difference in access to procedures. Medicare appears to offer as much access to African Americans as commercial providers. We conclude that equalizing access to types of insurance coverage would reduce only a small proportion of the race gap in access to the three procedures.