Effect of ethnicity on denial of authorization for emergency department care by managed care gatekeepers.
OBJECTIVE
After a pilot study suggested that African American patients enrolled in managed care organizations (MCOs) were more likely than whites to be denied authorization for emergency department (ED) care through gatekeeping, the authors sought to determine the association between ethnicity and denial of authorization in a second, larger study at another hospital.


METHODS
A retrospective cohort design was used, with adjustment for triage score, age, gender, day and time of arrival at the ED, and type of MCO.


RESULTS
African Americans were more likely to be denied authorization for ED visits by the gatekeepers representing their MCOs even after adjusting for confounders, with an odds ratio of 1.52 (95% CI = 1.18 to 1.94).


CONCLUSIONS
African Americans were more likely than whites to be denied authorization for ED visits. The observational study design raises the possibility that incomplete control of confounding contributed to or accounted for the association between ethnicity and gatekeeping decisions. Nevertheless, the questions that these findings raise about equity of gatekeeping indicate a need for additional research in this area.
Department of Biostatistics and Epidemiology, University of Pennsylvania Medical Center, and Philadelphia Emergency Medicine Research Consortium, Philadelphia, PA, USA. rlowe@cceb.med.upenn.edu
R A
RA
Lowe
S
S
Chhaya
K
K
Nasci
L J
LJ
Gavin
K
K
Shaw
M L
ML
Zwanger
J A
JA
Zeccardi
W C
WC
Dalsey
S B
SB
Abbuhl
H
H
Feldman
J A
JA
Berlin
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D001291:Attitude of Health Personnel / Q000208:ethnology*; D002648:Child; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration* / Q000592:standards; D008875:Middle Aged; D015143:Philadelphia; D012017:Referral and Consultation; D016079:Refusal to Treat; D012189:Retrospective Studies; D044465:White People / Q000706:statistics & numerical data*