"Managed Care in Three States: Experiences of Low-Income African Americans and Hispanics," published in the Fall 1999 issue of Inquiry, compares the health care experiences of poor, working-age African Americans and Hispanics in managed care plans with the experiences of those in fee-for-service (FFS) health plans in Florida, Tennessee, and Texas. The study was written by Wilhelmina A. Leigh, Marsha Lillie-Blanton, Rose Marie Martinez, and Karen Scott Collins.
The authors discover that, with some notable exceptions, access to care and patient satisfaction are similar among managed care and FFS enrollees. One important exception is that African-American managed care enrollees are twice as likely as their FFS counterparts to report problems getting required medical care. Another exception is that Hispanics in managed care rate their physicians' concern about them as "fair" or "poor" at twice the rate as those in FFS plans.
Neither managed care nor FFS plans are especially effective in assuring that African Americans or Hispanics have access to the health care system, the study finds. Roughly one of four African Americans and Hispanics rates as fair or poor his or her satisfaction with care, measured by overall service, waiting time required to get a doctor's appointment, and physician concern for the patient.
Eliminating auto-enrollment for Medicare beneficiaries in some states could improve satisfaction, the authors say, noting that African Americans with a choice of plans report having an easier time getting treatment and being more satisfied with the care they receive.
Because it is shifting from serving a primarily middle-class population to one that is more economically and racially diverse, the authors contend that managed care must be monitored for how well it serves various demographic groups. Health care purchasers and managed care plans should try to improve outcomes under managed care by fostering better physician/patient relations among diverse populations, reducing barriers to care, and allowing enrollees more choice to select plans.
Facts and Figures
- 72 percent of low-income African Americans were enrolled in managed care, compared with 55 percent of Hispanics and 63 percent of whites.
- 38 percent of African Americans and 42 percent of Hispanics in managed care plans did not have a regular provider, compared with 47 percent of African Americans and 52 percent of Hispanics in FFS plans.
- Spanish-speaking Hispanics were nearly twice as likely as their English-speaking counterparts to lack a regular provider.