Disparities in Access to Primary Care and Emergency Department Utilization in a Large Medicaid Program

摘要

Identifying and eliminating disparities are priorities for State Medicaid programs, especially in the context of increased enrollment through Medicaid expansion. We assessed racial, ethnic, regional, and managed care organization (MCO) differences, as well as time trends before and after Medicaid expansion, in primary care and emergency department (ED) utilization in a large Medicaid program. We performed a cross-sectional evaluation of data from Pennsylvania Medicaid from 2011-2015. Three primary care outcomes included: 1) adult access to primary care; 2) adolescent access to primary care; and 3) pediatric access to dental care. Our fourth outcome reflected ED utilization. We observed significant racial and regional disparities in access to primary care and ED utilization. In the context of Medicaid Expansion, adult primary care and ED utilization had wide racial disparities but were stable over time, while adolescent access to primary care worsened and pediatric access to dental care improved. Hispanic enrollees had higher primary care access compared with non-Hispanics. We additionally identified high and low-performing MCOs, and racial disparities within MCOs. In conclusion, disparity-reducing interventions should address region and MCO in addition to race, and should focus on post-Expansion trends. The state Medicaid program should consider these results in MCO recommendations and contracts.