Racial and ethnic differences in access to medical care in managed care plans.
OBJECTIVE
To examine the extent to which access differences between racial/ethnic minorities and whites in managed care plans are greater than such differences in other types of health plans.


METHODS
A nationally representative sample of 4,811 African American, 3,379 Hispanic, and 33,737 white nonelderly persons with public or private health insurance.


METHODS
A cross-sectional survey of households was conducted during 1996 and 1997. Commonly used measures of access to and utilization of medical care were constructed for individuals: (1) percentage of visits with a usual provider, (2) percentage with a regular provider, (3) visit with a physician in the past year, (4) hospital ER use, (5) last visit was to a specialist.


RESULTS
Fewer than 74 percent of Hispanics and African Americans had a regular provider compared to more than 78 percent of white Americans. Hispanics were least likely to have had their last doctor visit with a specialist (22 percent) compared to African Americans (26 percent) and whites (28 percent). Differences between ethnic/racial minorities and whites in managed care plans are similar to differences observed in non-managed care plans. Americans of all racial and ethnic backgrounds in managed care plans with gatekeeping are more likely to have a usual source of care, a regular provider, and lower use of specialists compared to persons in plans without gatekeeping.


CONCLUSIONS
Although greater access to primary care was shown among African Americans and Hispanics in managed care plans, the extent of the disparities between racial/ethnic minorities and whites in managed care is similar to disparities in other types of health plans.
Hargraves
J L
JL
Center for Studying Health System Change, Washington, DC 20024, USA.
Cunningham
P J
PJ
Hughes
R G
RG
D001741:Black or African American / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D020793:Gatekeeping; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D015273:Insurance Selection Bias; D008329:Managed Care Programs / Q000458:organization & administration / Q000706:statistics & numerical data*; D008511:Medicine; D011320:Primary Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013038:Specialization; D014481:United States; D014600:Utilization Review; D044465:White People / Q000706:statistics & numerical data*