Racial/ethnic differences in quality of care for North Carolina Medicaid recipients

Abstract

Background: National health care quality measures suggest that racial and ethnic minority populations receive inferior quality of care compared to whites across many health services. As the largest insurer of low-income and minority populations in the United States, Medicaid has an important opportunity to identify and address health care disparities.

Methods: Using 2006 Healthcare Effectiveness Data and Information Set (HEDIS) measures developed by the National Committee for Quality Assurance (NCQA), we examined quality of care for cancer screening, diabetes, and asthma among all eligible non-dual North Carolina Medicaid recipients by race and ethnicity.

Results: In comparison to non-Latino whites, non-Latino African Americans had higher rates of screening for breast cancer (40.7% vs. 36.7%), cervical cancer (60.5% vs. 54.6%), and colorectal cancer (25.5% vs. 20.6%) and lower rates of LDL testing among people with diabetes (61.8% vs. 65.7%) and appropriate asthma medication use (88.7% vs. 97.0%). A1C testing and retinal eye exam rates among people with diabetes were similar. Smaller racial/ethnic minority groups had favorable quality indicators across most measures.

Limitations: Comparability of findings to national population-based quality measures and other health plan HEDIS measures is limited by lack of case-mix adjustment.

Conclusions: For the health services examined, we did not find evidence of large racial and ethnic disparities in quality of care within the North Carolina Medicaid program. There is substantial room for improvement, however, in cancer screening and preventive care for Medicaid recipients as a whole.