Racial/Ethnic and County-level Disparity in Inpatient Utilization among Hawai'i Medicaid Population (original) (raw)
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2015
Abstract: Considerable interest exists in health care costs for the growing Micronesian population in the United States (US) due to their significant health care needs, poor average socioeconomic status, and unique immigration status, which impacts their access to public health care coverage. Using Hawai‘i statewide impatient data from 2010 to 2012 for Micronesians, whites, Japanese, and Native Hawaiians (N = 162,152 hospitalizations), we compared inpatient hospital costs across racial/ethnic groups using multivariable models including age, gender, payer, residence location, and severity of illness (SOI). We also examined total inpatient hospital costs of Micronesians generally and for Medicaid specifically. Costs were estimated using standard cost-to-charge metrics overall and within nine major disease categories determined by All Patient Refined Diagnosis Related Groups. Micronesians had higher unadjusted hospitalization costs overall and specifically within several disease catego...
BMC health services research, 2018
Native Hawaiians and Pacific Islanders (NHPIs) are one of the fasting growing racial groups in the United States (US). NHPIs have a significantly higher disease burden than the US population as a whole, yet they remain underrepresented in research. The purpose of this study is to examine factors associated with health care utilization among NHPIs. Drawing from the 2014 NHPI-National Health Interview Survey, we used stereotype logistic regressions to examine utilization of emergency department (ED) and outpatient services among 2172 individuals aged 18 and older. NHPIs with chronic diseases were twice as likely to be multiple ED users and nearly four times as likely to be frequent-users of outpatient services. Social support played a protective role in preventing multiple use of ED. Having a usual source of care made it more than eight times as likely to be a frequent-user of outpatient services. Use of eHealth information increased the odds of using ED and outpatient services. Abili...
Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, 2017
Native Hawaiians and Other Pacific Islanders (NHOPI) suffer from a number of poor health outcomes, such as high rates of overweight status, obesity, hypertension, and high rates of asthma and cancer mortality. In addition to a disproportionate burden of illness, barriers to health care access and utilization also exist. This study examines the effect of health insurance coverage on the health status of NHOPI in comparison to Asians. To analyze this relationship, the study uses the Behavioral Risk Factor Surveillance System (BRFSS) 2012 data and logistic regression. Findings show insured NHOPI were significantly more likely than insured Asian Americans to report poor or fair health after sequential cumulative adjustments of socioeconomic, lifestyle and behavioral factors, history of diagnosed diseases, and access to care (OR: 1.66, 95% CI:[1.34, 2.05]). Health insurance alone will not eliminate the present disparities experienced by NHOPI. Other barriers prohibit health care access f...
Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, 2014
Elderly (65+) Native Hawaiian, Filipino, and Japanese men and Filipino women have a higher risk of diabetes-related potentially preventable hospitalizations than Whites even when demographic factors and the higher diabetes prevalence in these populations is considered. The study objective was to determine if similar disparities are seen among the non-elderly (< 65). We used discharge data for all non-maternity hospitalizations by working-age adults (18-64 years) in Hawai'i from December 2006 to December 2010. Annual diabetes-related preventable hospitalization rates (by population diabetes prevalence) were compared by race/ethnicity (Japanese, Chinese, Native Hawaiian, Filipino, and White) and gender. Adjusted rate ratios (aRR) were calculated relative to Whites using multivariable models controlling for insurer, comorbidity, residence location, and age. After adjusting for ethnic-specific prevalence of diabetes and demographic factors, preventable hospitalizations rates were...
To measure possible racial/ethnic differences in a Florida disease management (DM) program on utilization of selected healthcare services for 4 chronic illnesses. Study Design: Pre-post comparison of utilization among 15,275 high-risk beneficiaries enrolled in DM in the Florida Medicaid program between October 2001 and October 2003. Methods: Two-part regression analyses of the effect of DM on annualized inpatient days, emergency department (ED) visits, and outpatient visits, controlling for relevant covariates. Annualized rates were used to adjust for differences in length of program enrollment. Results: Disease management patients in the postperiod had significantly lower annual rates of inpatient days, ED visits, and outpatient visits across most racial/ethnic groups. Disease management reduced utilization by a similar absolute amount in each racial/ethnic group. However, baseline disparities in utilization of inpatient days were not reduced by the DM program. Conclusions: Disease management has a similar effect across different racial/ethnic groups but may not ameliorate important baseline disparities. Evaluations of DM programs should account for baseline disparities in utilization and examine whether those disparities can be reduced through DM.
Ethnicity & disease, 2010
Large-scale comparison and comprehensive estimate on the access to health care and preventive services between Asian Americans/Pacific Islanders (AAPIs) and Non-Hispanic Whites (NHWs) has not been available. This study examines the racial disparities in access to health care and preventive services between AAPIs and NHWs in the USA. Cross-sectional study of access to health care and preventive services among AAPIs compared to NHWs, using data from Behavioral Risk Factor Surveillance System 2005 to 2007 among 908,154 respondents aged > or = 18 years. The percentages of AAPIs (aged > or = 18 years) who reported having a personal healthcare provider, a Pap test (women aged > or =18), a fecal occult blood test (aged > or = 50) a sigmoidoscopy/colonoscopy (aged > or = 50), a PSA test (men aged > or = 40), blood cholesterol checked (aged > or =18 yrs), and pneumococcal vaccination (aged > or = 65 yrs) were 76.7%, 83.1%, 27.5%, 47.5%, 35.5%, 74.2%, and 51.2%, respec...
Public health reports (Washington, D.C. : 1974)
Asian American and Pacific Islanders (AAPIs) historically have faced multiple social and racial/ethnic health disparities in the United States. We gathered national-level health-care data on AAPIs and examined medically underserved health service areas for them. We used 2000 U.S. Census data and the Bureau of Primary Health Care (BPHC) 2004 dataset for primary care physician full-time equivalents per 1000 population, as well as AAPI population, AAPI poverty, and AAPI limited English proficiency, to develop an index of medically underserved AAPI counties (MUACs). The index identifies U.S. counties that do not adequately serve AAPIs. We identified 266 counties of medically underserved health service areas for AAPIs across the nation, representing 12% of all U.S. counties. One hundred thirty-eight (52%) MUACs were not designated as BPHC medically underserved counties. Of these counties, 20 (14%) had an AAPI population of at least 10,000, and 29 (21%) had an AAPI population of at least ...
Preventing Chronic Disease, 2020
What is already known on this topic? Native Hawaiians, other Pacific Islanders, and Filipinos are rapidly growing populations in the United States, and these groups have a high prevalence of chronic disease risk factors. However, little is known about disease prevalence in these understudied populations. What is added by this report? We analyzed Hawai'i inpatient and emergency department data to assess the statewide prevalence of chronic conditions in acute care for patients aged 5 to 29 years and found that patients who had a chronic condition were disproportionately Native Hawaiian, Filipino, and Pacific Islander. What are the implications for public health practice? Our findings can help justify, guide, and support programs to address disparities in chronic conditions among young people who are at high risk for these conditions.