Dataset Information

Does Medicaid Managed Care Help Equalize Racial and Ethnic Disparities in Utilization?

ABSTRACT:

Objective

To estimate the impact of different forms of Medicaid managed care (MMC) delivery on racial and ethnic disparities in utilization.

Data source

Longitudinal, administrative data on 101,649 children in Kentucky continuously enrolled in Medicaid between January 1997 and June 1999. Outcomes considered are monthly professional, outpatient, and inpatient utilization.

Study design

We apply an intent-to-treat, instrumental variables analysis using the staggered geographic implementation of MMC to create treatment and control groups of children.

Principal findings

The implementation of MMC reduced monthly professional visits by a smaller degree for non-whites than whites (3.8 percentage points vs. 6.2 percentage points), thereby helping to equalize the initial racial/ethnic disparity in utilization. The Passport MMC program in the Louisville-centered region statistically significantly reduced disparities for professional visits (closing the gap by 8.0 percentage points), while the Kentucky Health Select MMC program in the Lexington-centered region did not. No substantive impact on disparities was found for either outpatient or inpatient utilization in either program.

Conclusions

We find evidence that MMC has the possibility to reduce racial/ethnic disparities in professional utilization. More work is needed to determine which managed care program characteristics drive this result.

SUBMITTER: Marton J

PROVIDER: S-EPMC4874821 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

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Publications

Does Medicaid Managed Care Help Equalize Racial and Ethnic Disparities in Utilization?

Marton James J Yelowitz Aaron A Shores Meredith M Talbert Jeffery C JC

Health services research 20151012 3

<h4>Objective</h4>To estimate the impact of different forms of Medicaid managed care (MMC) delivery on racial and ethnic disparities in utilization.<h4>Data source</h4>Longitudinal, administrative data on 101,649 children in Kentucky continuously enrolled in Medicaid between January 1997 and June 1999. Outcomes considered are monthly professional, outpatient, and inpatient utilization.<h4>Study design</h4>We apply an intent-to-treat, instrumental variables analysis using the staggered geographic ...[more]

PMID: 26456766

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Project description:Rationale & objectiveThe effects of race, ethnicity, socioeconomic status (SES), and disease severity on acute care utilization in patients with glomerular disease are unknown.Study designProspective cohort study.Setting & participants1,456 adults and 768 children with biopsy-proven glomerular disease enrolled in the Cure Glomerulonephropathy (CureGN) cohort.ExposureRace and ethnicity as a participant-reported social factor.OutcomeAcute care utilization defined as hospitalizations or emergency department visits.Analytical approachMultivariable recurrent event proportional rate models were used to estimate associations between race and ethnicity and acute care utilization.ResultsBlack or Hispanic participants had lower SES and more severe glomerular disease than White or Asian participants. Acute care utilization rates were 45.6, 29.5, 25.8, and 19.2 per 100 person-years in Black, Hispanic, White, and Asian adults, respectively, and 55.8, 42.5, 40.8, and 13.0, respectively, for children. Compared with the White race (reference group), Black race was significantly associated with acute care utilization in adults (rate ratio [RR], 1.76 [95% CI, 1.37-2.27]), although this finding was attenuated after multivariable adjustment (RR, 1.31 [95% CI, 1.03-1.68]). Black race was not significantly associated with acute care utilization in children; Asian race was significantly associated with lower acute care utilization in children (RR, 0.32 [95% CI 0.14-0.70]); no significant associations between Hispanic ethnicity and acute care utilization were identified.LimitationsWe used proxies for SES and lacked direct information on income, household unemployment, or disability.ConclusionsSignificant differences in acute care utilization rates were observed across racial and ethnic groups in persons with prevalent glomerular disease, although many of these difference were explained by differences in SES and disease severity. Measures to combat socioeconomic disadvantage in Black patients and to more effectively prevent and treat glomerular disease are needed to reduce disparities in acute care utilization, improve patient wellbeing, and reduce health care costs.

Dataset Information

Does Medicaid Managed Care Help Equalize Racial and Ethnic Disparities in Utilization?

Objective

Data source

Study design

Principal findings

Conclusions

Publications

Does Medicaid Managed Care Help Equalize Racial and Ethnic Disparities in Utilization?

Similar Datasets

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