Health plan effects on patient assessments of Medicaid managed care among racial/ethnic minorities.
OBJECTIVE
To examine the extent to which racial/ethnic differences in Consumer Assessment of Health Plans Study (CAHPS) ratings and reports of Medicaid managed care can be attributed to differential treatment by the same health plans (within-plan differences) as opposed to racial/ethnic minorities being disproportionately enrolled in plans with lower quality of care (between-plan differences).


METHODS
Data are from the National CAHPS Benchmarking Database (NCBD) 3.0. Data were analyzed using linear regression models to determine the overall effects, within-plan effects, and between-plan effects of race/ethnicity and language on patient assessments of care. Standard errors were adjusted for nonresponse weights and the clustered nature of the data.


METHODS
A total of 49,327 adults enrolled in Medicaid managed care plans in 14 states from 1999 to 2000.


RESULTS
Non-English speakers reported worse experiences compared to those of whites, while Asian non-English speakers had the lowest scores for most reports and ratings of care. An analysis of between-plan effects showed that African Americans, Hispanic-Spanish speakers, American Indian/Whites, and White-Other language were more likely than White-English speakers to be clustered in worse plans as rated by consumers. However, the majority of the observed racial/ethnic differences in CAHPS reports and ratings of care are attributable to within-plan effects. The ratio of between to within variance of racial/ethnic effects ranged from 0.07 (provider communication) to 0.42 (health plan rating).


CONCLUSIONS
The observed racial/ethnic differences in CAHPS ratings and reports of care are more a result of different experiences with care for people enrolled in the same plans than a result of racial/ethnic minorities being enrolled in plans with worse experiences. Health care organizations should engage in quality improvement activities to address the observed racial/ethnic disparities in assessments of care.
Weech-Maldonado
Robert
R
Pensylvania State University, University Park, PA 16801, USA. rxw25@psu.edu
Elliott
Marc N
MN
Morales
Leo S
LS
Spritzer
Karen
K
Marshall
Grant N
GN
Hays
Ron D
RD
D000328:Adult; D001741:Black or African American / Q000523:psychology; D001213:Asian / Q000523:psychology; D003258:Consumer Behavior; D005260:Female; D019538:Health Care Surveys; D006285:Health Planning; D006801:Humans; D007802:Language; D008297:Male; D008329:Managed Care Programs; D008484:Medicaid; D008913:Minority Groups / Q000523:psychology*; D011787:Quality of Health Care; D044465:White People / Q000523:psychology