National racial/ethnic and geographic disparities in experiences with health care among adult Medicaid beneficiaries
National racial/ethnic and geographic disparities in experiences with health care among adult Medicaid beneficiaries
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DOI：
10.1111/1475-6773.13106
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发表时间：
2019-02-01
影响因子：
3.4
通讯作者：
Elliott, Marc N.
中科院分区：
文献类型：
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作者：
Martino, Steven C.;Mathews, Megan;Elliott, Marc N.
目的调查是否有不同的种族/民族和农村/城市地位的成年医疗补助受益人的医疗保健经验。数据来源共有270243名受访者参加了2014-2015年全国成人医疗补助消费者对医疗保健提供者和系统的评估调查。研究设计线性回归用于估计少数种族/民族和非西班牙裔白色医疗补助受益人之间，以及居住在小城市地区、小城镇和农村地区与大城市地区的受益人之间的病例组合调整后的患者经验差异。相关措施包括获得所需的护理，快速获得护理，医生沟通和客户服务。主要调查结果相比，白色受益人，美洲印第安人/阿拉斯加原住民（AIAN）和亚洲/太平洋岛民（API）的受益人报告更糟糕的经验，而黑人受益人报告更好的经验。在0-100分的范围内，AIAN受益人的赤字为6-8分; API受益人的赤字为13-22分（P < 0.001）;黑人受益人的优势为3-5分（P < 0.001）。西班牙裔白色的差异是混合的。小城市地区、小城镇和偏远农村地区的受益人报告的经验（2-3分）明显好于大城市地区的受益人（P < 0.05），特别是在获得护理方面。种族/民族差异通常不因地理位置而异。结论：改善种族/少数民族和生活在大城市地区的个人的经验，应该是政策制定者探索提高医疗补助受益人的价值和提供护理的方法的高度优先事项。
Objectives To investigate whether health care experiences of adult Medicaid beneficiaries differ by race/ethnicity and rural/urban status. Data Sources A total of 270 243 respondents to the 2014-2015 Nationwide Adult Medicaid Consumer Assessment of Healthcare Providers and Systems Survey. Study Design Linear regression was used to estimate case mix adjusted differences in patient experience between racial/ethnic minority and non-Hispanic white Medicaid beneficiaries, and between beneficiaries residing in small urban areas, small towns, and rural areas vs large urban areas. Dependent measures included getting needed care, getting care quickly, doctor communication, and customer service. Principal Findings Compared with white beneficiaries, American Indian/Alaska Native (AIAN) and Asian/Pacific Islander (API) beneficiaries reported worse experiences, while black beneficiaries reported better experiences. Deficits for AIAN beneficiaries were 6-8 points on a 0-100 scale; deficits for API beneficiaries were 13-22 points (P's < 0.001); advantages for black beneficiaries were 3-5 points (P's < 0.001). Hispanic white differences were mixed. Beneficiaries in small urban areas, small towns, and isolated rural areas reported significantly better experiences (2-3 points) than beneficiaries in large urban areas (P's < 0.05), particularly regarding access to care. Racial/ethnic differences typically did not vary by geography. Conclusions Improving experiences for racial/ethnic minorities and individuals living in large urban areas should be high priorities for policy makers exploring approaches to improve the value and delivery of care to Medicaid beneficiaries.