Medicaid enrollees in minority groups experience worse care than white counterparts
Racial and ethnic minority enrollees reported significantly worse experiences on four key metrics, most revolving around care access.
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Racial and ethnic minorities who are enrolled in Medicaid experience notably worse care experiences than their white counterparts, finds a new study published in Health Affairs.
The research honed in on four key metrics: access to needed care, access to a personal doctor, timely access to a checkup or routine care, and timely access to specialty care. Racial and ethnic minority enrollees reported significantly worse experiences on all four metrics, and the disparities were primarily driven by different care experiences for minority enrollees within the same plan.
For example, compared to white enrollees, Black enrollees in the same plan consistently reported worse experiences of care, ranging between -1.2 percentage points for access to needed care and -4.5 percentage points for access to a personal doctor.
There were also significant within-plan disparities between white and Hispanic or Latino enrollees for all outcomes except access to needed care. And compared to white enrollees, Asian American, Native Hawaiian or other Pacific Islander enrollees within the same plan reported significantly worse experiences of care on all metrics, ranging between −8.6 percentage points for access to a personal doctor and −16.8 percentage points for timely access to specialty care.
There were also disparities found between plans, although they tended to not be as severe. There were not substantial between-plan disparities among white and Black enrollees, and there were modest, positive correlations between plan-level percentage of Hispanic or Latino enrollees and plan-level disparities in performance on all four outcomes- – meaning Hispanic or Latino enrollees experienced lower rates of disparities.
The study is one of a themed series being published in Health Affairs' February issue, which the publication said "offers a comprehensive look at peer-reviewed research at the intersection of racism and health care." The publication said the issue provides empirical evidence of racism in the health care system."
WHAT'S THE IMPACT
The estimates are comparable with disparities in perceived quality of care in a national survey of low-income adult patients with other forms of insurance – Medicare or commercially insured – and disparities in care coordination among Medicare Advantage patients.
For all four outcomes, plans in the highest quintile of Hispanic or Latino beneficiaries had smaller magnitudes of disparities for these enrollees than plans in the lowest quintile. Those findings build on prior work in Medicare Advantage suggesting that contracts with higher percentages of Hispanic or Latino beneficiaries have smaller white and Hispanic or Latino within-contract disparities than those with lower percentages of Hispanic or Latino beneficiaries.
Similarly, there were smaller magnitudes of disparities between the lowest and highest quintiles of Asian American, Native Hawaiian or other Pacific Islander enrollment for some outcomes.
Medicaid managed care plans are uniquely positioned to address racial and ethnic disparities in patient experience of care, researchers found. Many states use plan contracts as a primary lever to address such disparities in Medicaid. Identifying and addressing these disparities first requires improvements in data collection, data quality and the use of data to inform quality improvement initiatives. Despite national efforts to collect standardized data on race, ethnicity, and primary language, this data is largely incomplete among Medicaid managed care enrollees.
Beyond data collection, states and plans should consider stratifying patient experience measures by race and ethnicity, adopting health equity performance measures, and using data from these measures to develop interventions that address racial and ethnic disparities, researchers said. For example, California Medicaid managed care plans use a measure of health equity to identify disparities and undertake projects aimed at reducing disparities.
Other state strategies to address racial and ethnic health disparities include efforts to improve plans' cultural competency (for example, identifying preferred languages for communication), enrollee engagement (targeted outreach, development of programs to address identified disparities), and provider engagement (promoting culturally and linguistically diverse provider networks).
THE LARGER TREND
A number of studies in recent months have focused on disparities in healthcare in various forms. For instance, a study led by researchers from the Department of Health Care Policy in the Blavatnik Institute at Harvard Medical School in December 2021 found that Hispanic Medicare patients hospitalized with COVID-19 were more likely to die than non-Hispanic white Medicare beneficiaries.
Since the beginning of the pandemic, people of color have had a disproportionately higher risk for exposure to the virus and borne a markedly higher burden for more severe illness and worse outcomes, including hospitalization and death, according to the Centers for Disease Control and Prevention.
These risks stem from several factors. For example, people of color are more likely to work jobs with high rates of infection exposure, to live in more densely populated, multigenerational homes that heighten transmission risk among household members, and to have comorbidities – cardiovascular illness, diabetes, obesity, asthma – that drive the risk for more severe illness after infection. These groups also tend to have worse access to healthcare.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
