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Letters |

Health Outcomes for Black and White Patients in the Veterans Affairs Health Care System

John A. Hermos, MD
JAMA. 2001;285(14):1837-1838. doi:10.1001/jama.285.14.1837.
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To the Editor: Dr Jha and colleagues1 found lower mortality among black patients compared with white patients after treatment in VA health care facilities for comparably serious medical conditions. I offer several clinical observations that may help explain these findings.

The VA does not exclude those with insufficient funds or insurance. Ready access to medical care has been cited to explain why mental health outcomes for black patients in the VA system are equal to or better than those of white patients2,3 and why black veterans are more likely to use VA sources for their mental health care.3 Similar outcomes have been found in other military health care facilities where, unlike society at large, black infants do not have higher rates of low birth weight and neonatal mortality.4,5 In this regard, access to closely aligned VA mental health and social services must surely help to narrow the gaps in medical outcomes that disproportionately affect minority patients and those from disadvantaged lower socioeconomic groups. In addition, the VA's medical school affiliations and residency training programs promote closely monitored, data-based care that tends to preclude bias in the quality and quantity of care provided.

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