Measuring Trends in Racial/Ethnic Health Care Disparities

Cambridge Health Alliance/Harvard Medical School, Somerville, MA, USA.
Medical Care Research and Review (Impact Factor: 2.62). 10/2008; 66(1):23-48. DOI: 10.1177/1077558708323607
Source: PubMed


Monitoring disparities over time is complicated by the varying disparity definitions applied in the literature. This study used data from the 1996-2005 Medical Expenditure Panel Survey (MEPS) to compare trends in disparities by three definitions of racial/ethnic disparities and to assess the influence of changes in socioeconomic status (SES) among racial/ethnic minorities on disparity trends. This study prefers the Institute of Medicine's (IOM) definition, which adjusts for health status but allows for mediation of racial/ethnic disparities through SES factors. Black-White disparities in having an office-based or outpatient visit and medical expenditure were roughly constant and Hispanic-White disparities increased for office-based or outpatient visits and for medical expenditure between 1996-1997 and 2004-2005. Estimates based on the independent effect of race/ethnicity were the most conservative accounting of disparities and disparity trends, underlining the importance of the role of SES mediation in the study of trends in disparities.

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    • "Model covariates were chosen to assess racial/ethnic differences in medical expenditures while adjusting for the subjects' differences in health status, demographic, regional, health insurance status, and SES characteristics . Interactions between SES and race–ethnicity variables were included to allow for the differential return on these variables by race that has been noted in previous work on the MEPS data (Cook, McGuire, and Zuvekas 2009b). Variables used in the interaction terms were centered by subtracting their mean so that main effects results are readily interpretable (Kraemer and Blasey 2004). "
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