DeLaet 2002


Year: 2002

Title: Receipt of preventive services among privately insured minorities in managed care versus fee-for-service insurance plans

Country: United States

Age: Adult Only

Sex: Female

Population: Multiple Groups

Care Setting: Outpatient Ambulatory and Primary Care

Clinical Setting: Breast Cancer Screening

Data Level: National

Data Type: Government Survey

Data Source: Medical Expenditure Panel Survey

Conclusion: Disparities In Some Minority Groups

Health OutComes Reported: No

Mitigation: No

Free Text Conclusion: Hispanics less likely to have mammography compared to Whites. No difference between Black and White.

Abstract: OBJECTIVE: We compare preventive services utilization among privately insured African Americans and Hispanics in managed care organizations (MCOs) versus fee-for-service (FFS) plans. We also examine racial/ethnic disparities in the receipt of preventive services among enrollees in FFS or MCO plans. DESIGN: Analysis of the nationally representative 1996 Medical Expenditure Panel Survey. PARTICIPANTS: Participants included 1,120 Hispanic, 929 African-American, and 6,383 non-Hispanic white (NHW) adults age 18 to 64 years with private health insurance. MEASUREMENTS AND MAIN RESULTS: We examined self-reported receipt of physical examination, blood pressure measurement, cholesterol assessment, Papanicolau testing, screening mammography, and breast and prostate examinations. Multivariate modeling was used to adjust for age, gender, education, household income, and health status. Hispanics in MCOs were more likely than their FFS counterparts to report having preventive services, with adjusted differences ranging from 5 to 19 percentage points (P <.05 for physical examination, blood pressure measurement, breast examination and Pap smear). Among African Americans, such patterns were of a smaller magnitude. In both MCOs and FFS plans the proportion of African Americans reporting preventive services was equal to or greater than NHWs. In contrast, among Hispanic women in FFS, a non-statistically significant trend of fewer cancer screening tests than NHW's was observed (Pap smears 75% vs 80%; mammograms 66% vs 74%, respectively). In both MCO and FFS plans, Hispanics were less likely than NHWs to report having blood pressure and cholesterol measurement (P <.05). CONCLUSIONS: With the demise of traditional MCOs, reform efforts should incorporate those aspects of MCOs that were associated with greater preventive service utilization, particularly among Hispanics. Existing ethnic disparities warrant further attention.