MCOs shortchange minority Medicaid patients

February 23, 2004

Even when they are enrolled in the same Medicaid managed care organizations (MCOs), patients who are members of linguistic, racial or ethnic minorities report worse care than White English speakers, a Penn State-led study has shown.

Asian non-English speakers reported the worst experiences but the study found that African Americans, Hispanic Spanish speakers, and American Indians also continue to face barriers and lower quality of care, even after financial access has been assured by Medicaid. Dr. Robert Weech-Maldonado, assistant professor of health policy and human development who led the study, says, "The data did show that African Americans, Hispanic Spanish speakers and American Indians were more likely than White English speakers to be clustered in the worst plans as rated by consumers. However, our analysis found that the low reports of care by linguistic, racial and ethnic minorities are more a result of the different experiences with care for White versus minority people enrolled in the same plans than the minorities being in the poorly rated plans."

The study is detailed in the current (February) issue of the Journal of General Internal Medicine in a paper, "Health Plan Effects on Patient Assessments of Medicaid Managed Care Among Racial/Ethnic Minorities. "

The authors are Weech-Maldonado; Dr. Marc N. Elliott, RAND Health; Dr. Leo S. Morales, RAND Health; Ms. Karen Spitzer, University of California at Los Angeles; Dr. Grant Marshall, RAND Health; and Dr. Ron D. Hays, University of California at Los Angeles.

In 2000, 22.1 million people, or 58 percent of Medicaid recipients were enrolled in managed care plans and 21 percent of them were minorities. Medicaid is government health insurance program that provides medical coverage to certain individuals and families with low income and resources.

For their study, the researchers used a national database that included responses from 49,327 adults in 14 states, or 44 percent of the Medicaid population from 1999 to 2000. The study was the first to use a large, racial/ethnic diverse national sample to analyze the care reports of linguistic minorities in Medicaid managed care plans.

The analysis showed that language was the major barrier to overcome. Asian adults with limited English proficiency had the lowest reports of care of all racial/ethnic groups. However, Asian adults who spoke English did not differ significantly from White English speakers in their reports on getting needed care, the timeliness of care, provider communication and staff helpfulness and actually had more positive experiences with their plan service. A similar pattern was observed among Hispanics, where Spanish speakers had worse reports than did bilinguals or English speakers.

Weech-Moldonado notes, "Health care organizations need to take account of linguistic and cultural factors and provide interpreter services."
The study was supported by a grant from the Agency for Healthcare Research and Quality.

Penn State

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