Is patient HMO insurance or physician HMO participation related to racial disparities in primary care?
OBJECTIVE
To examine the relationship between racial disparities in common primary care procedures and patient HMO membership and physician level of HMO participation.


METHODS
Cross-sectional analysis.


METHODS
Data were obtained from a nationally representative sample of primary care office visits documented in the National Ambulatory Medical Care Survey for 1985, 1989-1992, and 1997-2000. Patient HMO membership was assessed based on reports by primary care physicians (defined as family physicians/general practitioners, internists, or obstetrician-gynecologists). Physician HMO participation was assessed based on the proportion of the physician's patients who were in an HMO. Patient characteristics (age, sex, race, insurance, diagnoses) and office procedures or interventions were determined by examining the physician report. Patients were adults aged 19 years or older.


RESULTS
In adjusted analyses, African Americans, compared with whites, had lower odds of receiving a Pap test (adjusted odds ratio [AORI = 0.76; 95% confidence interval [CI] = 0.65, .90), a rectal exam (AOR = 0.67; 95% CI = 0.54, 0.84), smoking cessation advice (AOR = 0.72; 95% CI = 0.58, 0.91), and mental health advice (AOR = 0.46; 95% CI = 0.29, 0.72), but had higher odds of receiving advice on diet and weight, and a follow-up appointment. Notably, there were no significant interactions between either patient HMO membership or physician level of HMO participation, patient race, and receipt of primary care services.


CONCLUSIONS
Neither patient HMO membership nor physician level of HMO participation is substantially associated with racial disparities in primary care.
Department of Family Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA. kevin_fiscella@umc.rochester.edu
Kevin
K
Fiscella
Peter
P
Franks
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D044469:Racial Groups; D012935:Social Justice; D014481:United States