Disparities/Minority Health

Medicaid may reduce racial/ethnic differences in preventable hospitalizations, but Medicaid managed care adds no extra benefit

Medicaid appears to reduce racial/ethnic differences in preventable hospitalizations of non-elderly adults. Now, a growing number of States are enrolling their Medicaid populations (predominantly ethnic/racial minorities) in managed care plans. However, according to a study by Agency for Healthcare Research and Quality (AHRQ) investigators, Jayasree Basu, Ph.D., M.B.A., Bernard Friedman, Ph.D., and Helen Burstin, M.D, M.P.H., Medicaid managed care (MMC) adds no extra benefit.

The researchers analyzed hospital discharge data from AHRQ's Healthcare Cost and Utilization Project State Inpatient database on adults aged 20 to 64 years who were hospitalized in New York, Pennsylvania, and Wisconsin. The results indicated weak evidence that preventable hospitalization rates consistently declined in any racial group in MMC relative to Medicaid fee-for-service (FFS) plans. The difference in preventable hospitalizations for Medicaid MMC was only significant for minorities in Wisconsin, where both blacks and Hispanics had a lower likelihood of preventable hospitalization in MMC than in Medicaid FFS.

Although Wisconsin has a relatively high MMC penetration, it also is a rural State with a small minority population (8.3 percent in 1997 compared with 23.4 percent and 11.6 percent in New York and Pennsylvania, respectively). While white residents in the more urban State of New York had a significantly lower likelihood of preventable hospitalizations in MMC than in Medicaid FFS, the opposite was found for white residents of the similarly urban State of Pennsylvania. Overall, the evidence is not strong that any particular racial group consistently benefited from MMC, or that any State consistently showed a favorable impact of MMC across racial groups. However, racial/ethnic disparities associated with the risk of preventable hospitalization were significantly less pronounced among Medicaid adults than among private FFS adults. Uniform coverage for Medicaid beneficiaries may reduce some of the racial inequalities in care access, conclude the researchers.

See "Preventable hospitalization and Medicaid managed care: Does race matter?", by Drs. Basu, Friedman, and Burstin, in the February 2006 Journal of Health Care for the Poor and Underserved 17, pp. 101-115. Reprints (AHRQ Publication No. 06-R028) are available from the AHRQ Publication Clearinghouse.

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