Barriers to care among racial/ethnic groups under managed care

Health Affairs

Volumn 19, Issue 4, 2000, Pages 65-75

  Phillips, Kathryn A ^a   Mayer, Michelle L ^b   Aday, Lu Ann ^c  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b LUCILE PACKARD CHILDREN S HOSPITAL   (United States)

^c UNIVERSITY OF TEXAS AT AUSTIN   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; EPIDEMIOLOGY; ETHNIC GROUP; FAMILY SIZE; HEALTH CARE DELIVERY; HEALTH INSURANCE; HUMAN; MEDICAID; PATIENT CARE; PATIENT SATISFACTION; STATISTICAL ANALYSIS; STATISTICS; UNITED STATES; UTILIZATION REVIEW;

CONTINUITY OF PATIENT CARE; DATA INTERPRETATION, STATISTICAL; ETHNIC GROUPS; FAMILY CHARACTERISTICS; HEALTH CARE SURVEYS; HEALTH SERVICES ACCESSIBILITY; HUMANS; MANAGED CARE PROGRAMS; MEDICAID; PATIENT SATISFACTION; UNITED STATES;

EID: 0034218484     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.19.4.65     Document Type: Article

References (33)

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13. About 7 percent were conducted in Spanish. Doris Lefkowitz, AHRQ, personal communication, 20 April 1999.
14. For details about MEPS, see R.M. Weinick, S.H. Zuvekas, and S.K. Drilea, Access to Health Care - Sources and Barriers, 1996, MEPS Research Findings no. 3, Pub. no. 98-0001 (Rockville, Md.: AHCPR, 1997); and the Agency for Health-care Research and Quality (AHRQ) Web site, www.meps.ahrq.gov.
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16. D.W. Garnick et al., "How Well Do Americans Understand Their Health Coverage?" Health Affairs (Fall 1993): 204-212; J. Eden, "Measuring Access to Care through Population-Based Surveys: Where Are We Now?" Health Services Research 33, no. 3 (Part 2) (1998): 685-707; and J. Kasper, "Asking about Access: Challenges for Surveys in a Changing Healthcare Environment," Health Services Research 33, no. 3 (Part 2) (1998): 715-740.
17. D.W. Garnick et al., "How Well Do Americans Understand Their Health Coverage?" Health Affairs (Fall 1993): 204-212; J. Eden, "Measuring Access to Care through Population-Based Surveys: Where Are We Now?" Health Services Research 33, no. 3 (Part 2) (1998): 685-707; and J. Kasper, "Asking about Access: Challenges for Surveys in a Changing Healthcare Environment," Health Services Research 33, no. 3 (Part 2) (1998): 715-740.
18. Weinick et al., Access to Health Care; and B. Kass, R. Weinick, and A. Monheit, Racial and Ethnic Differences in Health, 1996, MEPS Chartbook no. 2, Pub. no. 99-0001 (Rockville, Md.: AHCPR, 1999).
19. Weinick et al., Access to Health Care; and B. Kass, R. Weinick, and A. Monheit, Racial and Ethnic Differences in Health, 1996, MEPS Chartbook no. 2, Pub. no. 99-0001 (Rockville, Md.: AHCPR, 1999).
20. K.A. Phillips et al., "Use of Preventive Services by Managed Care Enrollees: An Updated Perspective," Health Affairs (Jan/Feb 2000): 102-116.
21. We examined these family-level barriers because they represent an overall measure of access. We did not combine family-level and individual-level data because of the differing perspectives and sample sizes.
22. Note that our results are slightly different from those reported by AHRQ in its access report, since that report grouped non-Hispanic whites and other races and used the reference person in the Round 1 instead of the Round 2 interview.
23. Access studies require the use of self-reported data because of the need to obtain information from respondents who do not seek care. Although the use of self-reported data introduces potential bias, respondents' perceptions of access and insurance coverage are likely to be as important as or even more important than actual access or coverage in determining outcomes.
24. We followed the AHRQ recommendation that denominators have at least 100 respondents. We also omitted results when cell sizes were less than 5.
25. Results are available upon request, to Kathryn Phillips, University of California, San Francisco, 3333 California Street, Room 420, Box 0613, San Francisco, California 94143.
26. Aday, Evaluating the Healthcare System; R. Andersen, "Revisiting the Behavioral Model and Access to Medical Care: Does It Matter?" Journal of Health and Social Behavior (March 1995): 1-10; and R. Andersen and P. Davidson, "Measuring Access and Trends," in Changing the U.S. Health Care System, ed. R. Andersen, T. Rice, and G. Kominski (San Francisco: Jossey-Bass, 1996), 21-59.
27. Aday, Evaluating the Healthcare System; R. Andersen, "Revisiting the Behavioral Model and Access to Medical Care: Does It Matter?" Journal of Health and Social Behavior (March 1995): 1-10; and R. Andersen and P. Davidson, "Measuring Access and Trends," in Changing the U.S. Health Care System, ed. R. Andersen, T. Rice, and G. Kominski (San Francisco: Jossey-Bass, 1996), 21-59.
28. Lillie-Blanton and Alfaro-Correa, In the Nation's Interest; and Commonwealth Fund, "National Comparative Survey of Minority Health" (New York: Commonwealth Fund, 1998).
29. Commonwealth Fund, "National Comparative Survey"; and Gawande et al., "Does Dissatisfaction with Health Plans Stem from Having No Choices?"
30. Commonwealth Fund, "National Comparative Survey"; and Gawande et al., "Does Dissatisfaction with Health Plans Stem from Having No Choices?"
31. Commonwealth Fund, "National Comparative Survey."
32. Weinick et al., Access to Health Care.
33. Berk et al., "Ability to Obtain Care."