Medicaid Managed Care and Racial Disparities in AIDS Treatment

By Guwani, James M.; Weech-Maldonado, Robert | Health Care Financing Review, Winter 2004 | Go to article overview

Medicaid Managed Care and Racial Disparities in AIDS Treatment


Guwani, James M., Weech-Maldonado, Robert, Health Care Financing Review


INTRODUCTION

Well-documented racial and ethnic differences in care have attracted increased attention from policymakers. Healthy People 2010, for example, established eliminating racial and ethnic disparities as a formal public policy goal for the U.S. health care system (U.S. Department of Health and Human Services, 2000). The AIDS epidemic in particular is recognized as a major health and socioeconomic problem that disproportionately affects low-income minorities who are at risk of poor access to care. Notwithstanding the implementation of health care policies to reduce disparities among populations with HIV/AIDS, significant racial/ethnic differences in access to care remain (Cunningham et al., 1999; Cunningham et al., 2000; Crystal et al., 2001).

In 1996, a CDC treatment guideline recommended the use of HAART for the clinical management of all HIV/AIDS patients with a CD4 cell count lower than 500 cells/mm3. CDC (1998) defines HAART as specific combinations of three classes of antiretroviral (ARV) drugs. Prior to the introduction of ARV therapies, HIV/AIDS patients had a very poor prognosis. The ARV drug treatment helps prevent HIV, the retrovirus that causes AIDS, from reproducing and infecting cells in the body. HAART treatment has been proven to be effective in controlling the deterioration of CD4 cells, which are the white blood cells that help direct the body's infection-fighting cells (Centers for Disease Control and Prevention, 1998). A study by Gebo et al. (2001) indicates that hospitalization rates among HIV patients decreased between 1995 and 1997 after the introduction of HAART. Valenfi (2001) concluded that the drug combination improves outcomes, patients live longer and have more sustained viral load suppression, and have lower health care costs. Despite the benefits, Black people have less access to HAART compared with White people (Shapiro et al., 1999; Andersen et al., 2000; Keruly, Conviser, and Moore, 2002).

Policymakers have traditionally focused on Medicaid insurance as one means of increasing access to care among vulnerable populations. Medicaid served more than 50 percent of all persons living with AIDS, and 90 percent of all children with AIDS, at an estimated cost of $35 billion to the Federal and State governments in 1998 (Health Care Financing Administration, 1998). Increasingly, government is relying on the managed care sector to provide coverage for the Medicaid population as a cost-containment mechanism. While 40 percent of Medicaid beneficiaries were enrolled in managed care in 1996 (Health Care Financing Administration, 1998), the percentage increased to more than 55 percent in 2000 (Henry J. Kaiser Family Foundation, 2000). Concurrently, the numbers of people with HIV/AIDS receiving services in managed care organizations (MCOs) have increased within the last two decades and concerns over access, quality of care, and satisfaction with services have grown as well.

Studies have produced inconclusive results on the effect of managed care on access to care for vulnerable populations. These inconsistent findings, perhaps, could be explained by variations in State practices, different payment methodologies, and different conception and definitions of access measures (Hughes and Luft, 1998; Szilagyi, 1998).

This study uses a nationally representative sample to analyze the effects of managed care on access to the recommended HIV/AIDS treatment (HAART) for Black and White Medicaid patients. Specifically, the study addresses three research questions:

* Does access to HAART differ between Black and White Medicaid patients?

* Does Medicaid managed care increase access to HAART?.

* Does Medicaid managed care reduce racial disparities in access to HAART?.

CONCEPTUAL FRAMEWORK

Medicaid managed care participants represent primarily those enrolled in health maintenance organizations (HMOs), prepaid health plans (PHPs), health insuring organizations (HIOs), and primary care case management (PCCM) (Centers for Medicare & Medicaid Services, 1997). …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Medicaid Managed Care and Racial Disparities in AIDS Treatment
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.