Expert Commentary

More minorities see doctors after Medicaid reform

Efforts at improving health equity in Oregon have reduced disparities in primary care visits among African American and Native American people.

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Efforts at improving health equity in Oregon have reduced disparities in primary care visits among African American and Native American people.

Health disparities in Oregon meant that while 18 percent of white women living in the state in 2011 did not have a regular care provider, the proportion was nearly twice as high for minority women — over 35 percent. White Oregonians also were expected to live for two more years than their minority peers.

Oregon overhauled its Medicaid program in 2012 with the goal of reducing these disparities through the use of coordinated care organizations (CCOs). CCOs are administrative bodies that organize and implement healthcare outreach strategies. The reform created 16 CCOs to work closely with community health workers and regional health equity coalitions to improve cultural competency and facilitate access to care.

A new study published in Health Affairs indicates that the reforms are achieving their desired results. The research, conducted by scholars at the Oregon Health & Science University, analyzed health insurance claims data to track changes in use of care before and after the Medicaid overhaul, from January 2010 to December 2014.

The study encompassed 601,217 Medicaid enrollees in its analysis. The researchers calculated that before the reform, black Medicaid enrollees had 27 percent higher emergency room visit rates than white enrollees. Black enrollees also saw primary care doctors and used other outpatient care less than white enrollees. Comparing American Indian and Alaska Native enrollees to white enrollees, similar patterns existed, though the researchers note they were of a smaller magnitude.

After the 2012 Medicaid reform, the researchers found that disparities between black and white enrollees for primary care and outpatient visits lessened. They found that the black-white disparity in primary care visits narrowed by 14.4 visits per 1,000 members each month — a 36 percent reduction. The Native American-white disparity for primary care visits decreased as well.

Disparities in other outpatient visits for both Native American and black enrollees also narrowed. Rates of emergency room visits, both overall and potentially avoidable, for both minority groups did not change significantly.

The researchers conclude that Oregon’s efforts to target disparities through Medicaid reform might be achieving this aim already. They note, however, that their findings cannot pinpoint specific initiatives responsible for these changes. The study also focuses on the Medicaid population in Oregon, which might limit the generalizability of the results to other states and might miss disparities between Medicaid enrollees and those with private insurance. The researchers conclude that the early success of the reforms might provide a model for other states looking to address health disparities.


For more research on health equity, we’ve covered explanatory factors involved in asthma disparities, strategies for reducing preventable hospitalizations, HIV, food stamps and more.

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