Differences in use of health services between White and African American children enrolled in Medicaid in North Carolina.
OBJECTIVE
Racial differences in health status and use of health services persist in the United States and are not completely explained by differences in socioeconomic status. This study examines differences in use of health services between White and African American children enrolled in Medicaid, controlling for other factors that affect service use. We make comparisons for use of primary preventive services, diagnosis and treatment of selected common childhood illnesses, and Medicaid expenditures.


METHODS
We linked Medicaid enrollment records, Medicaid paid claims data, and data on use of child WIC services to birth certificates for North Carolina children born in 1992 to measure use of health services and Medicaid expenditures by race for children ages 1, 2, 3, and 4. Logistic and Tobit regression models were used to estimate the independent effect of race, controlling for other variables such as low birth weight, WIC participation, and mother's age, education, and marital status. Since all children enrolled in Medicaid are in families of relatively low income, racial differences in socioeconomic status are partially controlled.


RESULTS
African American children had consistently lower Medicaid expenditures and lower use of health services than did White children, after statistically controlling for other maternal and infant characteristics that affect health service use, including child WIC participation. For example, total annual Medicaid expenditures were 207-303 dollars less for African American children than for White children, controlling for other variables. African America children were significantly less likely to receive well-child and dental services than were White children.


CONCLUSIONS
African American children enrolled in Medicaid use health services much less than White children, even when controlling for socioeconomic status and other factors that affect service use. Linking state administrative databases can be a cost-effective way of addressing important issues such as racial disparities in health service use.
Buescher
Paul A
PA
State Center for Health Statistics, North Carolina Division of Public Health, Raleigh, North Carolina 27699-1908, USA. paul.buescher@ncmail.net
Horton
Stephanie J
SJ
Devaney
Barbara L
BL
Roholt
Sarah J
SJ
Lenihan
Alice J
AJ
Whitmire
J Timothy
JT
Kotch
Jonathan B
JB
D001741:Black or African American / Q000706:statistics & numerical data*; D001719:Birth Certificates; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data*; D005522:Food Services / Q000191:economics / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008484:Medicaid / Q000706:statistics & numerical data*; D009657:North Carolina; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data; D012044:Regression Analysis; D012959:Socioeconomic Factors; D014600:Utilization Review; D044465:White People / Q000706:statistics & numerical data*