Racial/Ethnic Disparities in Access to Care Among Children: How Does Medicaid Do in Closing the Gaps?

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1 Figure 0 Racial/Ethnic Disparities in Access to Care Among Children: How Does Medicaid Do in Closing the Gaps? Julia Paradise Associate Director Kaiser Commission on Medicaid and the Uninsured Henry J. Kaiser Family Foundation for Medicaid Health Plans of America Annual Meeting Arlington, VA November 4, 2010

2 Figure 1 Background Medicaid (along with CHIP) is a major source of health coverage for all children, but especially children of color. 1 in 3 children overall Nearly 1 in 4 White children Nearly 1 in 2 African American and Hispanic children Medicaid has clearly reduced racial/ethnic disparities in health coverage among children, but it is also important to know whether it is helping to improve racial/ethnic equity in children s access to care. Our study examines how racial/ethnic disparities in access among Medicaid-enrolled children compare with disparities among privately insured and uninsured children.

3 Figure 2 About the Study Examined four indicators of access: Measures of entry : No usual source of care (USC) and no medical visit in past year Measures of perceived access: Problems obtaining necessary care and specialty care Pooled data from Medical Expenditure Panel Survey (MEPS) N= 15,280 children aged 1-18 with 12 months of either Medicaid or private insurance in 2003 or 2004 or uninsured for 12 months; study population limited to those who self-identify as African American/Black, Latino/Hispanic, or White Controlled for child s family income, gender, age, and health status, adult s education, MSA, and region Tested interaction between race/ethnicity and insurance coverage

4 Figure 3 Adjusted Proportion of Children 1-18 with No Usual Source of Care or Medical Visit by Insurance Group: % 32.9% 50.3% 18.9% 67.0% White, Non-Latino 53.4% 44.4% 36.6% 36.4% 32.5% African American, Non-Latino Latino 26.4% 23.6% 18.5% 0% 9.3% 8.9% 7.5% 7.6% 4.5% 5.0% Uninsured Private Medicaid Uninsured Private Medicaid No Usual Source of Care No Ambulatory Medical Visit NOTES: Adjusted rates computed based on a regression model that controlled for log of income, gender, age, health status, metropolitan statistical area, region, and the highest level of education achieved by an adult family member, and included a statistically significant interaction term for race x insurance. Statistically different from Whites at p<0.05. SOURCE: MEPS

5 70% 32.9% 50.3% 18.9% Figure 4 Adjusted Proportion of Children 1-18 with No Usual Source of Care or Medical Visit by Race/Ethnicity: % 36.6% 36.4% 67.0% 32.5% Uninsured Private Medicaid 44.4% 26.4% 23.6% 18.5% 0% 9.3% 8.9% 7.5% 7.6% 4.5% 5.0% African American Latino White African American Latino White No Usual Source of Care No Ambulatory Medical Visit NOTES: Adjusted rates computed based on a regression model that controlled for log of income, gender, age, health status, metropolitan statistical area, region, and the highest level of education achieved by an adult family member, and included a statistically significant interaction term for race x insurance. Statistically different from Medicaid at p<0.05. SOURCE: MEPS

6 Figure 5 Conclusion and Implications Medicaid works at least as well as private insurance in equalizing rates of access to health care for African American and Latino children relative to White children. In every racial/ethnic subgroup, access levels are better among insured children than among uninsured children. 16% of low-income children remain uninsured; most are eligible for public coverage. Still, while insurance whether public or private improves children s access to health care, evidence that it reduces racial/ethnic disparities in access is limited. Additional measures beyond ensuring coverage e.g., translation services, transportation, development of culturally competent health care providers are needed to close racial/ethnic gaps in access.

7 Figure 6 Racial/Ethnic Disparities in Access to Care Among Children: How Does Medicaid Do in Closing the Gaps? M Lillie-Blanton, J Paradise, M Thomas, P Jacobs, and B DiJulio Kaiser Family Foundation. Full report available at

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