Racial disparities in Medicaid home and community-based service utilization and expenditures among persons with multiple sclerosis

被引:41
作者
Fabius, Chanee D. [1 ,2 ]
Thomas, Kali S. [1 ,3 ]
Zhang, Tingting [1 ]
Ogarek, Jessica [1 ]
Shireman, Theresa I. [1 ]
机构
[1] Brown Univ, Sch Publ Hlth, Ctr Gerontol & Healthcare Res, Box G-S121 6,121 S Main St, Providence, RI 02912 USA
[2] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD 21205 USA
[3] US Dept Vet Affairs Med Ctr, Ctr Innovat Long Term Serv & Supports, Providence, RI USA
关键词
Home and community-based services; Disparities; Race; LONG-TERM-CARE; HEALTH-CARE; PREVALENCE; ETHNICITY; WAIVERS;
D O I
10.1186/s12913-018-3584-x
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: Medicaid home and community-based services (HCBS) provide services such as personal care, nursing, and home-delivered meals to aging adults and individuals with disabilities. HCBS are available to people across racial and ethnic groups, yet racial disparities in Medicaid HCBS utilization and expenditures have been understudied. Individuals with multiple sclerosis (MS) may be particularly impacted by HCBS, as nearly one-third requires assistance at home. The present study examined whether disparities exist in Medicaid HCBS utilization and expenditures among HCBS users with MS. Methods: We used secondary data to conduct a retrospective cohort analyses including 7550 HCBS recipients with MS. Demographic data was obtained from the Medicaid Analytic eXtract Personal Summary file, Medicaid HCBS service utilization and expenditures were obtained from the Other Therapy file, and comorbidities from the Medicare Chronic Condition Warehouse. Univariate and bivariate statistics were used to describe the sample and provide comparisons of characteristic by race. Logistic regression predicted the likelihood of using HCBS type and gamma regression was used to predict Medicaid HCBS expenditures. Results: Black HCBS users were younger, more likely to be female, and were more impaired than Whites. Multivariate analyses showed that Blacks were less likely to receive case management, equipment, technology and modification services, and nursing services compared to Whites. Additionally, Black men had the lowest Medicaid HCBS expenditures, while White men had the highest. Conclusions: Findings shed light on disparities among HCBS users with MS. As Blacks are already disproportionately affected by MS, these results reveal target areas for future research. Future work should examine the factors that contribute to these disparities, as well as determine the extent to which these inequities impact outcomes such as hospitalizations and nursing home admissions.
引用
收藏
页数:9
相关论文
共 34 条
[1]  
Abravanel MD, 2002, HOUS POLICY DEBATE, V13, P469
[2]   Caregiver perceptions associated with risk of nursing home admission for people with multiple sclerosis [J].
Buchanan, Robert J. ;
Radin, Dagmar ;
Huang, Chunfeng ;
Zhu, Li .
DISABILITY AND HEALTH JOURNAL, 2010, 3 (02) :117-124
[3]  
Cai X, 2015, MED CARE, V53, P18
[4]  
Clark-Hitt R, 2010, J HEALTH CARE POOR U, V21, P386, DOI 10.1353/hpu.0.0275
[5]   Allocation of case management resources in long-term care: Predicting high use of case management time [J].
Diwan, S .
GERONTOLOGIST, 1999, 39 (05) :580-590
[6]   Incidence and Prevalence of Multiple Sclerosis in the Americas: A Systematic Review [J].
Evans, Charity ;
Beland, Sarah-Gabrielle ;
Kulaga, Sophie ;
Wolfson, Christina ;
Kingwell, Elaine ;
Marriott, James ;
Koch, Marcus ;
Makhani, Naila ;
Morrow, Sarah ;
Fisk, John ;
Dykeman, Jonathan ;
Jette, Nathalie ;
Pringsheim, Tamara ;
Marrie, Ruth Ann .
NEUROEPIDEMIOLOGY, 2013, 40 (03) :195-210
[7]   Racial Differences in Medication Adherence: A Cross-Sectional Study of Medicare Enrollees [J].
Gerber, Ben S. ;
Cho, Young Ik ;
Arozullah, Ahsan M. ;
Lee, Shoou-Yih D. .
AMERICAN JOURNAL OF GERIATRIC PHARMACOTHERAPY, 2010, 8 (02) :136-145
[8]   Disparities in service utilization and expenditures for individuals with developmental disabilities [J].
Harrington, Charlene ;
Kang, Taewoon .
DISABILITY AND HEALTH JOURNAL, 2008, 1 (04) :184-195
[9]   Multiple sclerosis - Severity and progression rate in African Americans compared with whites [J].
Kaufman, MD ;
Johnson, SK ;
Moyer, D ;
Bivens, J ;
Norton, HJ .
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, 2003, 82 (08) :582-590
[10]   Do Noninstitutional Long-Term Care Services Reduce Medicaid Spending? [J].
Kaye, H. Stephen ;
LaPlante, Mitchell P. ;
Harrington, Charlene .
HEALTH AFFAIRS, 2009, 28 (01) :262-272