Racial disparity in influenza vaccination - Does managed care narrow the gap between African Americans and whites?

Context Substantial racial disparities exist in use of some health services . Whether managed care could reduce racial disparities in the use of preven tive services is not known. Objective To determine whether the magnitude of racial disparity in influen za vaccination is smaller among managed care enrollees than among those wit h fee-for-service insurance. Design, Setting, and Participants The 1996 Medicare Current Beneficiary Sur vey of a US cohort of 13674 African American and white Medicare beneficiari es with managed care and fee-for-service insurance. Main Outcome Measures Percentage of respondents (adjusted for sociodemograp hic characteristics, clinical comorbid conditions, and care-seeking attitud es) 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% we re enrolled in managed care. Overall, 65.8% received influenza vaccination. Whites were substantially more likely to be vaccinated than African Americ ans (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 fe e-for-service insurance to receive influenza vaccination (71.2% vs 65.4%; d ifference, 5.8%; 95% Cl, 3.6%-8.3%). The adjusted racial disparity in fee-f or-service was 24.9% (95% CI, 19.6%-30.1%) and in managed care was 18.6% (9 5% CI, 9.8%-27.4%). These adjusted racial disparities were both statistical ly significant, but the absolute percentage point difference in racial disp arity 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 vaccin ation for both whites and African Americans, but racial disparity in vaccin ation is not reduced in managed care. Our results suggest that additional e fforts are needed to adequately address this disparity.