Race/Ethnicity, Language, and Patients' Assessments of Care in Medicaid Managed Care

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 l...

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Bibliographic Details
Published in:	Health services research 2003-06, Vol.38 (3), p.789-808
Main Authors:	Weech-Maldonado, Robert, Morales, Leo S., Elliott, Marc, Spritzer, Karen, Marshall, Grant, Hays, Ron D.
Format:	Article
Language:	eng
Subjects:	Adult Attitude to Health - ethnology Benchmarking CAHPS Communication Barriers consumer assessments Consumer attitudes Consumer Behavior - statistics & numerical data Databases, Factual Demography Ethnic Groups - psychology Ethnic Groups - statistics & numerical data Female Health aspects Health care industry Humans Language Linear Models Male Managed care Managed Care Programs - standards Medicaid Medicaid - standards Meeting Presentation Middle Aged Minorities Minority & ethnic groups Minority Groups - psychology Minority Groups - statistics & numerical data patient experiences patient reports and ratings Quality of Health Care Quality of service Race Race/ethnicity Regression analysis State Health Plans - standards Statistics Studies United States
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Summary:	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® 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® 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® 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. Conclusions This study suggests that racial and ethnic minorities and persons with limited English proficiency face barriers to care, despite Medicaid‐enabled financial access. Health care organizations should address the observed disparities in access to care for racial/ethnic and linguistic minorities as part of their quality improvement efforts.
ISSN:	0017-9124 1475-6773