Health plan effects on patient assessments of medicaid managed care among racial/ethnic minorities (original) (raw)
Related papers
Race/Ethnicity, Language, and Patients' Assessments of Care in Medicaid Managed Care
Health Services Research, 2003
Objective. Consumer assessments of health care provide important information about how well health plans and clinicians meet the needs of the people they serve. The purpose of this study was to examine whether consumer reports and ratings of care in Medicaid managed care vary by race/ethnicity and language. Data Sources. Data were derived from the National CAHPS s Benchmarking Database (NCBD) 3.0 and consisted of 49,327 adults enrolled in Medicaid managed care plans in 14 states in 2000. Data Collection. The CAHPS s data were collected by telephone and mail. Surveys were administered in Spanish and English. The response rate across plans was 38 percent. Study Design. Data were analyzed using linear regression models. The dependent variables were CAHPS s 2.0 global rating items (personal doctor, specialist, health care, health plan) and multi-item reports of care (getting needed care, timeliness of care, provider communication, staff helpfulness, plan service). The independent variables were race/ethnicity, language spoken at home (English, Spanish, Other), and survey language (English or Spanish). Survey respondents were assigned to one of nine racial/ ethnic categories based on Hispanic ethnicity and race: White, Hispanic/Latino, Black/ African American, Asian/Pacific Islanders, American Indian/Alaskan native, American Indian/White, Black/White, Other Multiracial, Other Race/Ethnicity. Whites, Asians, and Hispanics were further classified into language subgroups based on the survey language and based on the language primarily spoken at home. Covariates included gender, age, education, and self-rated health. Principal Findings. Racial/ethnic and linguistic minorities tended to report worse care than did whites. Linguistic minorities reported worse care than did racial and ethnic minorities.
Health Services Research, 2015
Objective. To examine whether care experiences and immunization for racial/ethnic/language minority Medicare beneficiaries vary with the proportion of same-group beneficiaries in Medicare Advantage (MA) contracts. Data Sources/Study Setting. Exactly 492,495 Medicare beneficiaries responding to the 2008-2009 MA Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey. Data Collection/Extraction Methods. Mixed-effect regression models predicted eight CAHPS patient experience measures from self-reported race/ethnicity/language preference at individual and contract levels, beneficiary-level case-mix adjustors, along with contract and geographic random effects. Principal Findings. As a contract's proportion of a given minority group increased, overall and non-Hispanic, white patient experiences were poorer on average; for the minority group in question, however, high-minority plans may score as well as low-minority plans. Spanish-preferring Hispanic beneficiaries also experience smaller disparities relative to non-Hispanic whites in plans with higher Spanish-preferring proportions. Conclusions. The tendency for high-minority contracts to provide less positive patient experiences for others in the contract, but similar or even more positive patient experiences for concentrated minority group beneficiaries, may reflect cultural competency, particularly language services, that partially or fully counterbalance the poorer overall quality of these contracts. For some beneficiaries, experiences may be just as positive in some high-minority plans with low overall scores as in plans with higher overall scores.
Race/ethnicity, socioeconomic status, and satisfaction with health care
American journal of medical quality : the official journal of the American College of Medical Quality
The purpose of the present study was to evaluate the effects of race/ethnicity and socioeconomic status on consumer health care satisfaction ratings. The authors analyzed national data from the 2001 National Research Corporation Healthcare Market Guide Survey (N = 99 102). Four global and 3 composite ratings were examined. In general, satisfaction ratings were high across all global and composite measures; however, Asian/Pacific Islanders and Hispanics gave lower ratings than did whites, and African Americans gave a mix of higher and lower ratings (vs whites). Among the lowest ratings were those given by American Indians/Alaska Natives living in poverty. Race/ethnicity effects were independent of education and income. These findings are consistent with reports of continuing racial/ethnic disparities in both coverage and care. Programs to improve quality of care must specifically address these well-documented, severe, and persistent disparities.
Racial/ethnic differences in reporting versus rating of healthcare experiences
Medicine, 2018
Asians are reported to have poorer healthcare experience than non-Hispanic Whites (NHWs), but the sources of the differences are not understood. One explanation is Asian's reluctance to choose extreme responses in survey. We thus sought to compare NHW-Asian differences in responses to healthcare experience surveys when asked to report versus rate their experiences. Patients of an outpatient care system in 2013 to 2014 in the United States were studied. Patient experience surveys were sent after randomly selected clinic visits. Responses from 6 major Asian subgroups and NHWs were included (N = 61,115). The surveys used a combined questionnaire of Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) and Press Ganey surveys. CG-CAHPS questions are framed as "reporting" and Press Ganey questions as "rating" of experiences. We compared the proportion of favorable (or top box) responses to 2 related questions, one from CG-CAHPS and another from Press Ganey, and assessed racial/ethnic differences when using each of the 2 related questions, using a Pearson chi-squared test for independence. All Asian subgroups were less likely to select top box than NHWs for all questions. The Asian-NHW differences in "rating" questions were larger than the difference in related "reporting" questions. Of those who chose top box to CG-CAHPS questions (e.g., "Yes" on a question asking "Waited < 15 minutes"), their responses to related Press Ganey questions varied widely: 47% to 57% of Asian subgroups versus 67% of NHWs rated wait time as "Very good." The extent of racial/ethnic differences in patient-reported experiences varies based on how questions are framed. The observed poorer experiences by Asians are in part explained by their worse rating of similar objectively measurable experiences.
Examining racial and ethnic disparities in site of usual source of care
2007
Little is known about why minorities have a lower propensity to use private doctors' offices for their usual source of care than non-Hispanic whites. This study used the 2001 Commonwealth Fund's Health Care Quality Survey of adults to determine if this disparity is due to racial and ethnic differences in attitudes about health and healthcare, and perceptions of racial and ethnic discriminotLon in healthcare. We found that race and ethnic disparities at the site of the usual source of care persisted even after controlling for individuals' attitudes about health and healthcare, Ond their perceptions about racial and ethnic discrimination in healthcare. We found that the impact of attitudes and perceptions did vary by subgroups. These factors were important for Asians' site of usual source of care but had little impact on African Americans' site of usual of care. However, despite their differential impact by race and ethnicity, attitudes and perceptions were not the source of observed disparities in site of care. Therefore, in addition to focusing on provider-patient relationships, perhaps future research and policymakers should focus on system-level factors to explain and increase minority use of care in private physicians' offices.
2009
This brief presents findings from a recent study conducted by the Kaiser Family Foundation to examine how racial/ethnic disparities in access among Medicaid-enrolled children compare with disparities among privately insured and uninsured children. The analysis is based on data for a pooled sample of 15,280 African American, Latino, and White children aged 1-18, from the 2003 and 2004 Medical Expenditure Panel Survey (MEPS). We analyze data on four indicators of access to care-two that examine entry into the health care system and two measures of perceived ability to obtain access. We identify a racial/ethnic difference as a disparity only if statistically significant at p<0.05. Key findings are as follows: • While the vast majority of children fared well on the indicators examined, access problems persist for some children. In 2003-2004, about 8.6% of children lacked a usual source of care (USC), 27.1% had no ambulatory medical visit in the prior year, 9.6% of children with a prior medical visit reported problems getting necessary care, and 22.0% of children needing specialty care reported problems seeing a specialist. • Medicaid was on par with private insurance with regard to racial/ethnic disparities in children's access. Racial/ethnic disparities in access were no more likely among children in Medicaid than among privately insured children on these four indicators of access. • The presence and magnitude of disparities varied by the combination of a child's race/ethnicity and insurance group, and by the access measure examined. African American and Latino children lagged behind White children on the usual source of care measure in all three insurance groups; the disparity was largest-nearly threefold between uninsured Latino and White children. Privately insured African Americans and Latinos fared worse than Whites on the ambulatory visit measure, but in the Medicaid group, Latinos experienced no disadvantage, and in the uninsured group, African Americans experienced no gap. Evidence of racial/ethnic disparities
Health Affairs, 2008
Few studies have focused on Asian-white disparities. This study examines the use of seiected cancer screening and diabetes services under the traditional Medicare program of whites and Asians by socioeconomic status and among U.S. metropolitan statistical areas in which elderly Asians reside. It demonstrates that existing data, with enrichment, can be used to examine Asian-white disparities. It finds that Asians often receive poorer quality of care than whites, but disparities differ among metropolitan areas. This research enables policymakers to better understand and target resources to address Asianwhite disparities at the national and local community levels.
Racial and Ethnic Disparities in Services and the Patient Protection and Affordable Care Act
American Journal of Public Health, 2015
Objectives. We examined prereform patterns in insurance coverage, access to care, and preventive services use by race/ethnicity in adults targeted by the coverage expansions of the Patient Protection and Affordable Care Act (ACA). Methods. We used pre-ACA household data from the Medical Expenditure Panel Survey to identify groups targeted by the coverage provisions of the Act (Medicaid expansions and subsidized Marketplace coverage). We examined racial/ethnic differences in coverage, access to care, and preventive service use, across and within ACA relevant subgroups from 2005 to 2010. The study took place at the Agency for Healthcare Research and Quality in Rockville, Maryland. Results. Minorities were disproportionately represented among those targeted by the coverage provisions of the ACA. Targeted groups had lower rates of coverage, access to care, and preventive services use, and racial/ethnic disparities were, in some cases, widest within these targeted groups. Conclusions. Ou...