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Does Managed Care Narrow the Gap Between African Americans and Whites?

Eric C. Schneider, MD,MSc; Paul D. Cleary, PhD; Alan M. Zaslavsky, PhD; Arnold M. Epstein, MD,MA

JAMA. 2001;286:1455-1460.

Context  Substantial racial disparities exist in use of some health services. Whether managed care could reduce racial disparities in the use of preventive services is not known.

Objective  To determine whether the magnitude of racial disparity in influenza vaccination is smaller among managed care enrollees than among those with fee-for-service insurance.

Design, Setting, and Participants  The 1996 Medicare Current Beneficiary Survey of a US cohort of 13 674 African American and white Medicare beneficiaries with managed care and fee-for-service insurance.

Main Outcome Measures  Percentage of respondents (adjusted for sociodemographic characteristics, clinical comorbid conditions, and care-seeking attitudes) who received influenza vaccination and magnitude of racial disparity in influenza vaccination, compared among those with managed care and fee-for-service insurance.

Results  Eight percent of the beneficiaries were African American and 11% were enrolled in managed care. Overall, 65.8% received influenza vaccination. Whites were substantially more likely to be vaccinated than African Americans (67.7% vs 46.1%; absolute disparity, 21.6%; 95% confidence interval [CI], 18.2%-25.0%). Managed care enrollees were more likely than those with fee-for-service insurance to receive influenza vaccination (71.2% vs 65.4%; difference, 5.8%; 95% CI, 3.6%-8.3%). The adjusted racial disparity in fee-for-service was 24.9% (95% CI, 19.6%-30.1%) and in managed care was 18.6% (95% CI, 9.8%-27.4%). These adjusted racial disparities were both statistically significant, but the absolute percentage point difference in racial disparity between the 2 insurance groups (6.3%; 95% CI, –4.6% to 17.2%) was not.

Conclusion  Managed care is associated with higher rates of influenza vaccination for both whites and African Americans, but racial disparity in vaccination is not reduced in managed care. Our results suggest that additional efforts are needed to adequately address this disparity.

Author Affiliations: Department of Health Policy and Management, Harvard School of Public Health, and Division of General Medicine, Brigham and Women's Hospital (Drs Schneider and Epstein), and Department of Health Care Policy, Harvard Medical School (Drs Cleary and Zaslavsky), Boston, Mass.

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