Racial and ethnic differences in parents' assessments of pediatric care inMedicaid managed care

Objective. This study examines whether parents' reports and ratings of pedi atric health care vary by race/ethnicity and language in Medicaid managed c are. Data Sources. The data analyzed are from the National Consumer Assessment o f Health Plans (CAHPS (R)) Benchmarking Database 1.0 and consist of 9,540 c hildren enrolled in Medicaid managed care plans in Arkansas, Kansas, Minnes ota, Oklahoma, Vermont, and Washington state from 1997 to 1998. Data Collection. The data were collected by telephone and mail, and surveys were administered in Spanish and English. The mean response rate for all p lans was 42.1 percent. Study Design. Data were analyzed using multiple regression models. The depe ndent variables are CAMPS 1.0 ratings (personal doctor, specialist, health care, health plan) and reports of care (getting needed care, timeliness of care, provider communication, staff helpfulness, plan service). The indepen dent variables are race/ethnicity (white, African American, American Indian , Asian, and Hispanic), Hispanic language (English or Spanish), and Asian l anguage (English or other), controlling for gender, age, education, and hea lth status. Principal Findings. Racial/ethnic minorities had worse reports of care than whites. Among Hispanics and Asians language barriers had a larger negative effect on reports of care than race/ethnicity. For example, while Asian no n-English-speakers had lower scores than whites for staff helpfulness (beta = -20.10), timeliness of care (beta = - 18.65), provider communication (be ta = -17.19), plan service (beta = - 10.95), and getting needed care (beta = -8.11), Asian English speakers did not differ significantly from whites o n any of the reports of care. However, lower reports of care for racial/eth nic groups did not translate necessarily into lower ratings of care. Conclusions. Health plans need to pay increased attention to racial/ethnic differences in assessments of care. This study's finding that language barr iers are largely responsible for racial/ethnic disparities in care suggests that linguistically appropriate health care services are needed to address these gaps.