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Ethnic disparities in access to care are a continuing problem in the United States. Managed care, which focuses on preventive care, appears to improve the use of preventive care for Hispanics and whites but not for blacks or Asians/Pacific Islanders, finds a study supported in part by the Agency for Healthcare Research and Quality (HS10771 and HS10856). Lead author, Jennifer S. Haas, M.D., M.S.P.H., and colleagues at the University of California, San Francisco, examined 1996 data on preventive health care use by people enrolled in fee-for-service (FFS) and managed care plans from AHRQ's Medical Expenditure Panel Survey (MEPS) of noninstitutionalized U.S. civilians.
They examined use by whites, blacks, Hispanics, and Asians/Pacific Islanders of four preventive health screenings: mammography within the past 2 years for women aged 50-75; clinical breast exam within the past 2 years for women between 40 and 75; Pap smear within the past 2 years for women between 18 and 65; and cholesterol screening within the past 5 years for men and women older than 20 years. After adjustment for age and other factors, Hispanic women enrolled in a managed care plan reported higher rates of mammography (predicted probability of 86 vs. 72 percent for women insured by FFS plans), breast exam, and Pap smear than Hispanic women with FFS insurance.
Whites insured by managed care were also more likely than whites with FFS coverage to receive mammography and cholesterol screening. There were no significant differences in the receipt of preventive care for blacks or Asians/Pacific Islanders by type of insurance. Managed care may improve access to a usual source of care for Hispanics, who are much more likely to lack a usual source of care than whites. On the other hand, use of many preventive tests by blacks has approached rates of use by whites in recent years. Also, the sample size was limited for blacks and Asians/Pacific Islanders for some preventive care measures, which may have limited the ability to find ethnic differences in preventive care in these groups.
More details are in "Effect of managed care insurance on the use of preventive care for specific ethnic groups in the United States," by Dr. Haas, Kathryn A. Phillips, Ph.D., Dean Sonneborn, M.A., and others, in Medical Care 40(9), pp. 743-751, 2002.
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