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Medicaid policies and other local factors may affect disparities in use of diabetes-related health care services

Racial and ethnic differences in the use of health care services by Medicaid-insured patients with diabetes varies from one State to another, according to a study supported in part by the Agency for Healthcare Research and Quality (HS10152). In addition, differences in the use of outpatient visits were generally inversely related to hospitalization rates.

Local factors, including variations in State Medicaid policies, may affect racial and ethnic differences in use of health care services, according to researchers from the UCLA School of Medicine, RAND, and Beth Israel Deaconess Medical Center in Boston. Researchers analyzed 1994 and 1995 State Medicaid data from California, Georgia, and New Jersey on use of outpatient office visits to physicians, emergency department (ED) visits, and hospitalizations among diabetes patients.

In New Jersey, blacks had 9 percent fewer outpatient visits and 15 percent more hospitalizations than whites. In Georgia, blacks had 47 percent more outpatient visits and 19 percent fewer hospitalizations than whites. In California, there was no significant difference between blacks and whites in outpatient visits, but blacks had 18 percent more hospitalizations. There was little difference in emergency department (ED) use between blacks and whites across all three States.

In New Jersey, Hispanics had 14 percent more outpatient visits than whites, but there was no significant difference in hospitalizations. Yet, Hispanics in California had 12 percent fewer outpatient visits and 9 percent more hospitalizations than whites. Hispanic patients had 21 percent and 32 percent fewer ED visits than whites in New Jersey and California, respectively.

Patient risk factors did not explain these racial/ethnic differences in health care use. Also, since all Medicaid recipients are poor, racial/ethnic differences in financial resources are unlikely to explain these findings.

See "Racial and ethnic differences in utilization of health services in patients with diabetes enrolled in Medicaid," by Roberto B. Vargas, M.D., M.P.H., Roger B. Davis, Sc.D., Ellen P. McCarthy, Ph.D., M.P.H., and others, in the Journal of Health Care for the Poor and Underserved 15, pp. 562-575.

Editor's Note: Another AHRQ-supported study of care disparities shows that a county's racial and/or ethnic composition influences the relationship between individual race or ethnicity and use of preventive care. For more details, see Benjamins, M.R., Kirby, J.B., and Huie, S.A. (2004). "County characteristics and racial and ethnic disparities in the use of preventive services." Preventive Medicine 39, pp. 704-712. Reprints (AHRQ Publication No. 05-R036) are available from the AHRQ Publications Clearinghouse.

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