In diagnostic coronary angiography, a dye is injected into heart blood vessels so that X-rays can be used to accurately diagnose heart disease. Test utilization trends in the Northeast between 1995 and 2003 showed that African Americans were about 25 percent less likely to receive coronary angiography compared to whites. Angiography utilization among whites changed little following the New Jersey reforms, but the number of tests provided to black patients increased, closing the black-white gap in use rates. In nearby states the racial gap did not change during the study period.

Prior to the reforms, 26 New Jersey hospitals (about one in four) were licensed to provide the testing. In response to complaints from hospital officials that angiography capacity was too limited, state officials changed the regulations to permit more hospitals to perform the test while assuring that the service is delivered only when medically appropriate and that high quality

standards are achieved. The new regulations, which doubled the number of hospitals licensed for the testing, also required new angiography facilities to create outreach plans to improve access for traditionally underserved groups, including racial minorities.

However, none of the minority directed outreach efforts seems to have made any difference, but the overall increase in the number of sites did.

Previously, the 26 hospitals had no difficulty filling their beds with well-insured patients which left little capacity to serve the less-preferred, less well-insured patients. Once the new facilities came on line, the well-insured could go to other places, and many did. The hospitals licensed before reform – many located in urban areas – could no longer fill their angiography service with the well-insured because the new hospitals were attracting many of them away.

“We believe that in light of these circumstances, the ‘incumbent’ (pre-reform) hospitals preferred to collect some revenue through Medicaid to collecting none, thus leading these hospitals to expand services to underserved groups including black patients,” Cantor said. “We do not believe that this was a conscious decision on the part of the incumbent hospitals, many of which have strong community service missions, but a response to changing circumstances.”

The Center for State Health Policy (www.cshp.rutgers.edu) was established within Rutgers Institute for Health, Health Care Policy, and Aging Research in 1999 to inform, support and stimulate sound and creative state health policy in New Jersey and around the nation.

The study was funded by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services under grant number R01-HS014191. It was co-authored by Cantor and Derek DeLia, faculty at Rutgers’ CSHP; Amy Tiedemann, Ph.D. and Ava Stanley, M.D., M.P.H., former members of the center research staff; and Karl Kronebusch, a faculty member at Baruch College at the City University of New York.

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.

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