Effect of Ethnicity on Denial of Authorization for Emergency Department Care by Managed Care Gatekeepers

Abstract

Abstract. Objective: After a pilot study suggested that African American patients enrolled in managed care organizations (MCOs) were more likely than whites to be denied authorization for emergency department (ED) care through gatekeeping, the authors sought to determine the association between ethnicity and denial of authorization in a second, larger study at another hospital. Methods: A retrospective cohort design was used, with adjustment for triage score, age, gender, day and time of arrival at the ED, and type of MCO. Results: African Americans were more likely to be denied authorization for ED visits by the gatekeepers representing their MCOs even after adjusting for confounders, with an odds ratio of 1.52 (95% CI = 1.18 to 1.94). Conclusions: African Americans were more likely than whites to be denied authorization for ED visits. The observational study design raises the possibility that incomplete control of confounding contributed to or accounted for the association between ethnicity and gatekeeping decisions. Nevertheless, the questions that these findings raise about equity of gatekeeping indicate a need for additional research in this area. half of those ED visits are for nonurgent problems. 4,5 Because charges for ED care are typically higher than charges for care of comparable illnesses treated in traditional primary care settings 6 and because of a belief that patients may benefit from the enhanced continuity of care provided in a traditional primary care setting, some policy makers have advocated strategies to reduce ED use for nonurgent problems. [7][8][9][10]

Identifying barriers to emergency care services

“…Providers and patients may not speak the same language, preventing basic needs of communication during an emergency (Flores et al, 1998;Free et al, 1999). Immigrant status or prejudices against ethnic groups are reported to be another category of barrier to receive timely access to the emergency care needed (Zambrana et al, 1994;Ku and Matani, 2001;Lowe et al, 2001).…”

Perceptions of women's infertility: what do physicians see?

“…This suggests that once physicians know that infertility is a problem, they are likely to recommend comparable treatments for patients regardless of race or socioeconomic status. This lack of bias is admirable, particularly when one considers the preponderance of research which documents racial and class-based inequalities in health care (15,17,21,25,39). For example, van Ryn and Burke (40) found that physicians perceived African American and poor patients more negatively than European American patients on a number of dimensions.…”

“…Studies evaluating medical care for coronary artery disease consistently report lower quality treatment for African American patients, in comparison to European Americans (21)(22)(23). Moreover, compared with their European American counterparts, African Americans are more likely to be denied authorization for emergency care by managed care gatekeepers, to encounter greater difficulties in accessing their primary care providers, and to rate their visits with physicians as less participatory (24)(25)(26).…”

Lack of Ethnic Differences in End-of-Life Care in the Veterans Health Administration

“…[16][17][18][19][20] Several studies have reported no significant ethnic differences for patient rating of pain. 21,22 Many studies, however, have demonstrated a difference in the actual treatment of pain.…”