Race/ethnicity, language, and patients' assessments of care in Medicaid managed care.
OBJECTIVE
Consumer assessments of health care provide important information about how well health plans and clinicians meet the needs of the people they serve. The purpose of this study was to examine whether consumer reports and ratings of care in Medicaid managed care vary by race/ethnicity and language.


METHODS
Data were derived from the National CAHPS Benchmarking Database (NCBD) 3.0 and consisted of 49,327 adults enrolled in Medicaid managed care plans in 14 states in 2000.


METHODS
The CAHPS data were collected by telephone and mail. Surveys were administered in Spanish and English. The response rate across plans was 38 percent.


METHODS
Data were analyzed using linear regression models. The dependent variables were CAHPS 2.0 global rating items (personal doctor, specialist, health care, health plan) and multi-item reports of care (getting needed care, timeliness of care, provider communication, staff helpfulness, plan service). The independent variables were race/ethnicity, language spoken at home (English, Spanish, Other), and survey language (English or Spanish). Survey respondents were assigned to one of nine racial/ethnic categories based on Hispanic ethnicity and race: White, Hispanic/Latino, Black/African American, Asian/Pacific Islanders, American Indian/Alaskan native, American Indian/White, Black/White, Other Multiracial, Other Race/Ethnicity. Whites, Asians, and Hispanics were further classified into language subgroups based on the survey language and based on the language primarily spoken at home. Covariates included gender, age, education, and self-rated health.


RESULTS
Racial/ethnic and linguistic minorities tended to report worse care than did whites. Linguistic minorities reported worse care than did racial and ethnic minorities.


CONCLUSIONS
This study suggests that racial and ethnic minorities and persons with limited English proficiency face barriers to care, despite Medicaid-enabled financial access. Health care organizations should address the observed disparities in access to care for racial/ethnic and linguistic minorities as part of their quality improvement efforts.
Weech-Maldonado
Robert
R
Department of Health Policy and Administration, Pennsylvania State University, University Park 16801, USA.
Morales
Leo S
LS
Elliott
Marc
M
Spritzer
Karen
K
Marshall
Grant
G
Hays
Ron D
RD
D000328:Adult; D001294:Attitude to Health / Q000208:ethnology*; D019985:Benchmarking; D003144:Communication Barriers; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005006:Ethnicity / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007802:Language; D016014:Linear Models; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D008484:Medicaid / Q000592:standards*; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology* / Q000706:statistics & numerical data; D011787:Quality of Health Care; D013221:State Health Plans / Q000592:standards*; D014481:United States