Study finds widespread care disparities in Medi-Cal program
Ethnicity, race major factors; African Americans hit disproportionately
In the first external analysis of the California Department of Health Service's Medi-Cal Managed Care program, researchers from the UCLA Department of Family Medicine found widespread health care disparities based on ethnicity, race and language throughout the system.
And African Americans are bearing the brunt of it.
These disparities can lead to a lower quality of care for the state's minority populations, resulting in poorer health for these groups, as well as higher health care and social costs. The UCLA researchers make a series of recommendations aimed at correcting these disparities.
The study findings were presented March 27 during a health policy briefing in Sacramento aimed at informing legislative staff and academics about the challenges facing Medi-Cal. The University of California's California Program on Access to Care, which funded the study, sponsored the briefing.
"Medicaid is the largest provider of health care services to low-income ethnic minority populations in our nation," said Dr. Michael Rodriguez, associate professor of family medicine at the David Geffen School of Medicine at UCLA and co-director of the Network for Multicultural Research on Health and Healthcare. "Therefore, it is in Medicaid's best interest to reduce health care disparities in order to promote good health, reduce preventable medical complications and reduce health care costs."
The researchers examined 2006 data from eight health plans that contract with California's Medi-Cal Managed Care Division (MMCD) - Blue Cross of California, Central Coast Alliance for Health, Contra Costa Health Plan, Health Net, Inland Empire Health Plan, Kern Health Systems, LA Care and San Francisco Health Plan. The eight plans together serve about 70 percent of MMCD beneficiaries.
Among MMCD enrollees, 55.2 percent are Hispanic, 16.6 percent are non-Hispanic white, 13.1 percent are black/African-American and 11.7 percent are Asian/Pacific Islander. Primary languages spoken among enrollees are English, Spanish, Southeast Asian languages such as Cambodian and Thai, and others, such as Farsi, Polish and American Sign Language.
Researchers analyzed 16 care areas within three broad categories: child and adolescent health care, women's health care, and chronic and other diseases. They found that quality of care was significantly lower in 10 of 16 areas for African Americans, compared with other groups. Additionally, care quality was lower for non-Hispanic whites in 3 of 16 measures, and - most surprisingly - English speakers received lower quality of care than non-English speakers in 13 of 16 measures, possibly due in part to efforts by MMCD to improve services for those with limited English-language skills.
Specific findings included the following:
* 62 percent of African American children received all six recommended childhood vaccinations, compared with 67 percent of non-Hispanic whites, 78 percent of Hispanics and 82 percent of Asians/Pacific Islanders.
* 43 percent of African American women received breast cancer screenings, compared with 49 percent of non-Hispanic whites, 55 percent of Hispanics and 56 percent of Asians/Pacific Islanders.
* At 66 percent, African Americans with diabetes have the lowest rate of hemoglobin AIc testing, compared with 71 percent for non-Hispanic whites, 75 percent for Hispanics and 76 percent for Asians/Pacific Islanders.
Among the researchers' policy recommendations are:
* Standardize ethnicity, race and primary-language questions in the Medi-Cal applications.
* Implement a method to validate ethnic, racial and primary-language data after it has been collected.
* Develop networks to electronically update ethnicity, race and language data to county welfare records.
* Require health plans to incorporate a reduction in these disparities into their quality-improvement projects.
* Research the reasons behind these disparities.
The UCLA Department of Family Medicine provides comprehensive primary care to entire families, from newborns to seniors. Its services include low-risk obstetrical care and prenatal and inpatient care at Santa Monica-UCLA Medical Center and Orthopedic Hospital and outpatient care at the Les Kelley Family Health Center in Santa Monica and the Mid-Valley Family Health Center in Van Nuys, Calif. The department is also a leader in family medicine education, for both medical students and residents, and houses a significant research unit focusing on geriatric issues and health care disparities among immigrant families and minority communities in Los Angeles and California.