Effect of ethnicity on denial of authorization for emergency department care by managed care gatekeepers

Objective: After a pilot study suggested that African American patients enr olled in managed care organizations (MCOs) were more likely than whites to be denied authorization for emergency department (ED) care through gatekeep ing, the authors sought to determine the association between ethnicity and denial of authorization in a second, larger study at another hospital. Meth ods: A retrospective cohort design was used, with adjustment for triage sco re, age, gender, day and time of arrival at the ED, and type of MCO. Result s: African Americans were more likely to be denied authorization for ED vis its by the gatekeepers representing their MCOs even after adjusting for con founders, with an odds ratio of 1.52 (95% CI = 1.18 to 1.94). Conclusions: African Americans were more likely than whites to be denied authorization f or ED visits. The observational study design raises the possibility that in complete control of confounding contributed to or accounted for the associa tion between ethnicity and gatekeeping decisions. Nevertheless, the questio ns that these findings raise about equity of gatekeeping indicate a need fo r additional research in this area.