The population of the United States is becoming increasing multi-ethnic. Yet despite this increase in numbers, minorities continue to face substantial barriers to receiving health care. Discrimination may cause minorities to have jobs with lower wages and less comprehensive benefits. Residential segregation may result in poorer access to health. Discrimination may cause minorities have to have jobs with lower wages and less comprehensive benefits. Residential segregation may result in poorer access to health care and poorer health status. These factor may make racial and ethnic minorities fare in the managed care environment. Our hypotheses will be explored in two phases. In Phase I of our study, we will use national data from the Medical Expenditure Panel Survey (MEPS) and the Community Tracking Survey (CTS). Linking these data with our own database of community and managed and managed care market characteristics, we will examine whether community and marker characteristics influence the quality of care and health status of minorities. We will examine the hierarchy of relationships between: (1) a person, (2) his or her health plan (if any), (3) community characteristics, and (4) market characteristics. In Phase II, we will focus in more detail on a small number of communities using data from the Community Tracking Survey (CTS). Our multi-disciplinary team has demonstrated expertise in analyzing survey data (particularly MEPS), measuring market characteristics, and examining racial and ethnic disparities in the quality of care. The proposed study will address several of the limitations of our current understanding of the relationship between managed care and racial and ethnic disparities in the quality of care and health status. The proposed study will: (1) suggest strategies that will lead to better access to care and health outcomes for minorities, (2) build on the strengths of MEPS and CTS, but also addresses its deficiencies by adding data on markets and communities, and (3) directly address the goals of the DHHS Initiative to Eliminate Racial and Ethnic Disparities in Health.
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