Skip to main content
NCBI home page
Health Services Research logoLink to Health Services Research
. 2001 Jul;36(3):575–594.

Racial and ethnic differences in parents' assessments of pediatric care in Medicaid managed care.

R Weech-Maldonado 1, L S Morales 1, K Spritzer 1, M Elliott 1, R D Hays 1
PMCID: PMC1089243  PMID: 11482590

Abstract

OBJECTIVE: This study examines whether parents' reports and ratings of pediatric health care vary by race/ethnicity and language in Medicaid managed care. DATA SOURCES: The data analyzed are from the National Consumer Assessment of Health Plans (CAHPS) Benchmarking Database 1.0 and consist of 9,540 children enrolled in Medicaid managed care plans in Arkansas, Kansas, Minnesota, Oklahoma, Vermont, and Washington state from 1997 to 1998. DATA COLLECTION: The data were collected by telephone and mail, and surveys were administered in Spanish and English. The mean response rate for all plans was 42.1 percent. STUDY DESIGN: Data were analyzed using multiple regression models. The dependent variables are CAHPS 1.0 ratings (personal doctor, specialist, health care, health plan) and reports of care (getting needed care, timeliness of care, provider communication, staff helpfulness, plan service). The independent variables are race/ethnicity (white, African American, American Indian, Asian, and Hispanic), Hispanic language (English or Spanish), and Asian language (English or other), controlling for gender, age, education, and health status. PRINCIPAL FINDINGS: Racial/ethnic minorities had worse reports of care than whites. Among Hispanics and Asians language barriers had a larger negative effect on reports of care than race/ethnicity. For example, while Asian non-English-speakers had lower scores than whites for staff helpfulness (beta = -20.10), timeliness of care (beta = -18.65), provider communication (beta = -17.19), plan service (beta = -10.95), and getting needed care (beta = -8.11), Asian English speakers did not differ significantly from whites on any of the reports of care. However, lower reports of care for racial/ethnic groups did not translate necessarily into lower ratings of care. CONCLUSIONS: Health plans need to pay increased attention to racial/ethnic differences in assessments of care. This study's finding that language barriers are largely responsible for racial/ethnic disparities in care suggests that linguistically appropriate health care services are needed to address these gaps.

Full text

PDF
575

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aharony L., Strasser S. Patient satisfaction: what we know about and what we still need to explore. Med Care Rev. 1993 Spring;50(1):49–79. doi: 10.1177/002570879305000104. [DOI] [PubMed] [Google Scholar]
  2. Andrulis D. P. Access to care is the centerpiece in the elimination of socioeconomic disparities in health. Ann Intern Med. 1998 Sep 1;129(5):412–416. doi: 10.7326/0003-4819-129-5-199809010-00012. [DOI] [PubMed] [Google Scholar]
  3. Brick J. M., Kalton G. Handling missing data in survey research. Stat Methods Med Res. 1996 Sep;5(3):215–238. doi: 10.1177/096228029600500302. [DOI] [PubMed] [Google Scholar]
  4. Carrasquillo O., Orav E. J., Brennan T. A., Burstin H. R. Impact of language barriers on patient satisfaction in an emergency department. J Gen Intern Med. 1999 Feb;14(2):82–87. doi: 10.1046/j.1525-1497.1999.00293.x. [DOI] [PubMed] [Google Scholar]
  5. Cleary P. D., McNeil B. J. Patient satisfaction as an indicator of quality care. Inquiry. 1988 Spring;25(1):25–36. [PubMed] [Google Scholar]
  6. Cleary P. D. The increasing importance of patient surveys. Now that sound methods exist, patient surveys can facilitate improvement. BMJ. 1999 Sep 18;319(7212):720–721. doi: 10.1136/bmj.319.7212.720. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. David R. A., Rhee M. The impact of language as a barrier to effective health care in an underserved urban Hispanic community. Mt Sinai J Med. 1998 Oct-Nov;65(5-6):393–397. [PubMed] [Google Scholar]
  8. Davies A. R., Ware J. E., Jr Involving consumers in quality of care assessment. Health Aff (Millwood) 1988 Spring;7(1):33–48. doi: 10.1377/hlthaff.7.1.33. [DOI] [PubMed] [Google Scholar]
  9. Gross D. A., Zyzanski S. J., Borawski E. A., Cebul R. D., Stange K. C. Patient satisfaction with time spent with their physician. J Fam Pract. 1998 Aug;47(2):133–137. [PubMed] [Google Scholar]
  10. Hall J. A., Dornan M. C. Patient sociodemographic characteristics as predictors of satisfaction with medical care: a meta-analysis. Soc Sci Med. 1990;30(7):811–818. doi: 10.1016/0277-9536(90)90205-7. [DOI] [PubMed] [Google Scholar]
  11. Halstead D., Becherer R. C. Surveying patient satisfaction among disadvantaged managed care customers. Health Care Strateg Manage. 1998 Nov;16(11):15–18. [PubMed] [Google Scholar]
  12. Handler A., Rosenberg D., Raube K., Kelley M. A. Health care characteristics associated with women's satisfaction with prenatal care. Med Care. 1998 May;36(5):679–694. doi: 10.1097/00005650-199805000-00008. [DOI] [PubMed] [Google Scholar]
  13. Harpole L. H., Orav E. J., Hickey M., Posther K. E., Brennan T. A. Patient satisfaction in the ambulatory setting. Influence of data collection methods and sociodemographic factors. J Gen Intern Med. 1996 Jul;11(7):431–434. doi: 10.1007/BF02600192. [DOI] [PubMed] [Google Scholar]
  14. Hayes R. P., Baker D. W. Methodological problems in comparing English-speaking and Spanish-speaking patients' satisfaction with interpersonal aspects of care. Med Care. 1998 Feb;36(2):230–236. doi: 10.1097/00005650-199802000-00011. [DOI] [PubMed] [Google Scholar]
  15. Hu D. J., Covell R. M. Health care usage by Hispanic outpatients as function of primary language. West J Med. 1986 Apr;144(4):490–493. [PMC free article] [PubMed] [Google Scholar]
  16. Kerr E. A., Hays R. D., Lee M. L., Siu A. L. Does dissatisfaction with access to specialists affect the desire to leave a managed care plan? Med Care Res Rev. 1998 Mar;55(1):59–77. doi: 10.1177/107755879805500104. [DOI] [PubMed] [Google Scholar]
  17. Kravitz R. L. Patients' expectations for medical care: an expanded formulation based on review of the literature. Med Care Res Rev. 1996 Mar;53(1):3–27. doi: 10.1177/107755879605300101. [DOI] [PubMed] [Google Scholar]
  18. Lavizzo-Mourey R., Mackenzie E. R. Cultural competence: essential measurements of quality for managed care organizations. Ann Intern Med. 1996 May 15;124(10):919–921. doi: 10.7326/0003-4819-124-10-199605150-00010. [DOI] [PubMed] [Google Scholar]
  19. Leigh W. A., Lillie-Blanton M., Martinez R. M., Collins K. S. Managed care in three states: experiences of low-income African Americans and Hispanics. Inquiry. 1999 Fall;36(3):318–331. [PubMed] [Google Scholar]
  20. Manson A. Language concordance as a determinant of patient compliance and emergency room use in patients with asthma. Med Care. 1988 Dec;26(12):1119–1128. doi: 10.1097/00005650-198812000-00003. [DOI] [PubMed] [Google Scholar]
  21. Meredith L. S., Siu A. L. Variation and quality of self-report health data. Asians and Pacific Islanders compared with other ethnic groups. Med Care. 1995 Nov;33(11):1120–1131. doi: 10.1097/00005650-199511000-00005. [DOI] [PubMed] [Google Scholar]
  22. Morales L. S., Cunningham W. E., Brown J. A., Liu H., Hays R. D. Are Latinos less satisfied with communication by health care providers? J Gen Intern Med. 1999 Jul;14(7):409–417. doi: 10.1046/j.1525-1497.1999.06198.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Murray-García J. L., Selby J. V., Schmittdiel J., Grumbach K., Quesenberry C. P., Jr Racial and ethnic differences in a patient survey: patients' values, ratings, and reports regarding physician primary care performance in a large health maintenance organization. Med Care. 2000 Mar;38(3):300–310. doi: 10.1097/00005650-200003000-00007. [DOI] [PubMed] [Google Scholar]
  24. Newcomer R., Preston S., Harrington C. Health plan satisfaction and risk of disenrollment among social/HMO and fee-for-service recipients. Inquiry. 1996 Summer;33(2):144–154. [PubMed] [Google Scholar]
  25. Pérez-Stable E. J., Nápoles-Springer A., Miramontes J. M. The effects of ethnicity and language on medical outcomes of patients with hypertension or diabetes. Med Care. 1997 Dec;35(12):1212–1219. doi: 10.1097/00005650-199712000-00005. [DOI] [PubMed] [Google Scholar]
  26. Rossiter L. F., Langwell K., Wan T. T., Rivnyak M. Patient satisfaction among elderly enrollees and disenrollees in Medicare health maintenance organizations. Results from the National Medicare Competition Evaluation. JAMA. 1989 Jul 7;262(1):57–63. [PubMed] [Google Scholar]
  27. Sisk J. E., Gorman S. A., Reisinger A. L., Glied S. A., DuMouchel W. H., Hynes M. M. Evaluation of Medicaid managed care. Satisfaction, access, and use. JAMA. 1996 Jul 3;276(1):50–55. [PubMed] [Google Scholar]
  28. Snyder R. E., Cunningham W., Nakazono T. T., Hays R. D. Access to medical care reported by Asians and Pacific Islanders in a West Coast physician group association. Med Care Res Rev. 2000 Jun;57(2):196–215. doi: 10.1177/107755870005700204. [DOI] [PubMed] [Google Scholar]
  29. Taira D. A., Safran D. G., Seto T. B., Rogers W. H., Kosinski M., Ware J. E., Lieberman N., Tarlov A. R. Asian-American patient ratings of physician primary care performance. J Gen Intern Med. 1997 Apr;12(4):237–242. doi: 10.1046/j.1525-1497.1997.012004237.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Valdez R. B., Giachello A., Rodriguez-Trias H., Gomez P., de la Rocha C. Improving access to health care in Latino communities. Public Health Rep. 1993 Sep-Oct;108(5):534–539. [PMC free article] [PubMed] [Google Scholar]
  31. Zastowny T. R., Roghmann K. J., Cafferata G. L. Patient satisfaction and the use of health services. Explorations in causality. Med Care. 1989 Jul;27(7):705–723. doi: 10.1097/00005650-198907000-00005. [DOI] [PubMed] [Google Scholar]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust

RESOURCES