Effect of managed care insurance on the use of preventive care for specific ethnic groups in the United States.
BACKGROUND
Ethnic disparities in access to health care is a persistent problem in the US. Despite the broad implementation of managed care, there is little information that specifically addresses how this type of coverage may affect ethnic disparities.


OBJECTIVE
To examine the effect of managed care insurance on the use of preventive care for different ethnic groups.


METHODS
Observational cohort using the 1996 Medical Expenditure Panel Survey.


METHODS
Adults with health insurance who report their ethnicity as white, black, Hispanic, or Asian/Pacific Islander.


METHODS
(1) Mammography within the past 2 years for women between 50 and 75 years of age; (2) clinical breast exam within the past 2 years for women between 40 and 75 years; (3) Papanicolaou smear within the past 2 years for women between 18 and 65 years; and (4) cholesterol screening within the past 5 years for men and women older than the age of 20 years.


RESULTS
Hispanic people enrolled in a managed care plan report higher rates of mammography, breast exam, and Papanicolaou smear compared with Hispanic people with fee-for-service insurance. For example, the adjusted predicted probability of a mammogram for Hispanic women with managed care was 85.6% compared with 72.4% for Hispanic women with fee-for-service coverage (risk difference: 13.2%; 95% CI for the risk difference 0.7%-25.7%). White persons with managed care are also more likely than white persons with fee-for-service coverage to receive mammography and cholesterol screening. Managed care is not associated with less preventive care for any ethnic group.


CONCLUSIONS
In this nationally representative household survey, it was found that managed care is associated with greater use of some preventive care for Hispanic persons and white persons than fee-for-service insurance. Despite a focus on prevention, the benefits of managed care are not apparent for black persons or Asian/Pacific Islanders.
Haas
Jennifer S
JS
Institute for Health Policy Studies, Division of General Internal Medicine, San Francisco General Hospital, CA, USA. jhaas@itsa.ucsf.edu
Phillips
Kathryn A
KA
Sonneborn
Dean
D
McCulloch
Charles E
CE
Liang
Su-Ying
SY
D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005006:Ethnicity; D018588:Fee-for-Service Plans; D005260:Female; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D006937:Hypercholesterolemia / Q000175:diagnosis; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data; D008329:Managed Care Programs; D008875:Middle Aged; D065006:Papanicolaou Test; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D014481:United States; D014626:Vaginal Smears / Q000706:statistics & numerical data