Do managed care plans' tiered networks lead to inequities in care for minority patients?

Health Affairs

Volumn 27, Issue 4, 2008, Pages 1160-1166

  Brennan, Troyen A ^a   Spettell, Claire M ^a   Fernandes, Joaquim ^a   Downey, Roberta L ^a   Carrara, Lisa M ^a  

^a AETNA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ETHNICITY; HEALTH CARE; HEALTH CARE PERSONNEL; HEALTH CARE PLANNING; HEALTH INSURANCE; HEALTH STATUS; HUMAN; PATIENT CARE;

FEMALE; HEALTH EXPENDITURES; HEALTHCARE DISPARITIES; HUMANS; MALE; MANAGED CARE PROGRAMS; MINORITY GROUPS; ORGANIZATIONAL CASE STUDIES; QUALITY ASSURANCE, HEALTH CARE; SPECIALTIES, MEDICAL; UNITED STATES;

EID: 48149084158     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.27.4.1160     Document Type: Article

References (15)

1. L. Casalino et al., "Will Pay-for-Performance and Quality Reporting Affect Health Care Disparities?" Health Affairs 26, no. 3 (2007): w405-w414 (published online 10 April 2007; 10.1377/hlthaff.26.3.w405).
2. L. Casalino, "The Unintended Consequences of Measuring Quality on the Quality of Health Care," New England Journal of Medicine 341, no. 15 (1999): 1147-1150.
3. K. Holt et al., "Mammography Self-Report and Mammography Claims: Racial, Ethnic, and Socioeconomic Disparities among Elderly Women," Medical Care 44, no. 6 (2006): 513-518.
4. H.H. Pham, "Delivery of Preventive Services to Older Adults by Primary Care Physicians," Journal of the American Medical Association 294, no. 4 (2005): 473-481.
5. The clinical performance measures are described in Appendix A, available online at http://content.healthaffairs.org/cgi/content/full/27/4/1160/DC1.
6. Episode Treatment Groups (ETG), Release 6.0, 2006; and Ingenix Inc., Marketbasket System, version 3.1, 2003-2005, Cave Consulting Group LLC, Foster City, California.
7. For information about the minority patient composition for these providers, see Appendix B, available online as in Note 5.
8. U.S. Census Bureau, United States Census 2000, Summary File 1 (SF-1), http://www.census.gov/main/www/cen2000.html (accessed 27 March 2008).
9. Although the dependent variable is a proportion and bounded by 0 and 100, it is not unlike other variables that are bounded although not explicitly so, such as age. With the large sample sizes in this analysis, the central limit theorem applies; the distribution was approximately normal, sufficient to use t-tests (SAS/STAT, SAS 9.1.3). Weights were based on the number of patients seen per provider. Differences were evaluated at the 0.05 level.
10. See Appendix C, available online as in Note 5.
11. See Appendix D; ibid.
12. Institute of Medicine, Crossing the Quality Chasm: A New Health System for the Twenty-first Century (Washington: National Academies Press, 2001).
13. A.M. Epstein, "Health Care in America-Still Too Separate, Not Yet Equal," New England Journal of Medicine 351, no. 6 (2004): 603-605.
14. P. Franks and K. Fiscella, "Effect of Patient Socioeconomic Status on Physician Profiles for Prevention, Disease Management, and Diagnostic Testing Costs," Medical Care 40, no. 8 (2002): 717-724.
15. S.T. Lindau, A. Basu, and S.A. Leitsch, "Health Literacy as a Predictor of Follow-up after an Abnormal Pap Smear: A Prospective Study," Journal of General Internal Medicine 21, no. 8 (2006): 829-834.