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

James Marton,Jeffery C Talbert,Meredith Shores,Aaron Yelowitz

doi:10.1111/1475-6773.12396

Abstract

ObjectiveTo estimate the impact of different forms of Medicaid managed care (MMC) delivery on racial and ethnic disparities in utilization.Data SourceLongitudinal, 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 DesignWe apply an intent‐to‐treat, instrumental variables analysis using the staggered geographic implementation of MMC to create treatment and control groups of children.Principal FindingsThe 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.ConclusionsWe 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.

Highlights

One system factor receiving attention is managed care coverage
Professional services typically represent physician services, but they could include services provided at locations other than physician offices, such as dental or public health clinics. We focus on these outcome measures for two reasons: our desire to be consistent with previous work evaluating the implementation of Medicaid managed care (MMC) in Kentucky and the fact that these categories of utilization were reimbursed differently by the two managed care organizations (MCOs)
In the full sample, described in the far left panel, 20.5 percent initially lived in the Passport region, 12.3 percent in the Kentucky Health Select Plan (KHS) region, and the remaining 67.2 percent in the rest of Kentucky

Summary

Introduction

Managed care could either reduce or exacerbate disparities. Such plans typically coordinate care through closed provider networks and gatekeeper physicians. By reducing choice, such coordination could increase utilization disparities if racial/ethnic minorities face greater transportation and scheduling barriers. There is concern that gatekeepers may increase disparities if they are less likely to advocate for low-income, minority patients (Balsa, Cao, and McGuire 2007). If racial/ethnic minorities are more likely to have fragmented care, an increased emphasis on coordination and uniform practice standards could reduce disparities (Haas et al 2002; Cook 2007). Coordination may improve because some plans give providers performancebased bonuses for extending office hours, maintaining an appointment reminder system, and accepting new patients (Marton, Yelowitz, and Talbert 2014)

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