Racial and Ethnic Differences in Healthcare Utilization among Medicare Fee-For-Service Enrollees
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Division of General Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA; 2Peter T. Paul College of Business and Economics, University of New Hampshire, Durham, NH, USA; 3Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; 4ESSEC Business School, Cergy-Pontoise, France; 5Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.
J Gen Intern Med DOI: 10.1007/s11606-019-05426-4 © Society of General Internal Medicine 2019
INTRODUCTION
Most existing literature about racial/ethnic disparities focuses on differences among Blacks and Hispanics.1 Asian Americans (Asians), the fastest growing population in the USA,2 are found to be low healthcare utilizers.3, 4 However, it is unclear whether this arises from differences in access to care (i.e., lack of health insurance) or care-seeking behavior. A closer examination of potential differences in healthcare utilization among Asians is important for many reasons. First, recent studies have shown poor health outcomes among Asians and we hypothesize that this may be associated with low healthcare utilization.5 Second, continuity of care or frequent ambulatory care utilization is associated with improved healthcare outcomes and lower rates of emergency room visits. Third, the Asian population has been growing faster than the overall national population, which means that their health outcomes will have increasing significance in national healthcare outcomes.2 The purpose of this study is to address an important gap in the literature by exploring healthcare utilization among continuously insured Medicare fee-for-service beneficiaries, with a focus on Asians.
visits, evaluation and management office visits, and consultations), emergency room visits, and short-stay hospitalizations, using ICD9-CM and CPT codes. To focus on the lack of use of services, our main outcomes were dichotomous indicators (0/1) of non-use of ambulatory clinic visits, emergency room visits, and hospitalizations during 1 January 2010–31 December 2012 (or until date of death). The five racial/ethnic groups identified in the data were non-Hispanic Whites, Blacks, Hispanics, Asians, and Others. We included socio-demographic characteristics (race/ethnicity, gender, age, Medicaid and Medicare dual eligibility, and region) and geographic characteristics (community type, provider availability, and distance to nearest hospital) known to be associated with healthcare utilization. We characterized individual baseline health status based on indicators (0/1) of baseline prevalence of 23 chronic conditions developed by the Centers for Medicare and Medicaid Services and included in Medicare claims data.6 We used zip code–level geocoded data to obtain area-level healthcare access indicators. We performed descriptive analyses of the key outcomes and covariates by race and ethnicity. Our core analysis used Poisson regression models to estimate the r
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