Racial and Ethnic Differences in Healthcare Utilization among Medicare Fee-For-Service Enrollees

Kim, Young Ho; Liebschutz, Jane M.; Conigliaro, Joseph; DeGeorge, Jean; Hanchate, Amresh

doi:10.1007/s11606-019-05426-4

Cited by 7 publications

(4 citation statements)

References 4 publications

(4 reference statements)

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“…Despite higher rates of internet use and technology adoption reported among English-speaking Asian Americans, 33 our study findings concerning telemedicine use mirror early findings of lower patient portal adoption rates among Asian Americans. 34 Less use of telemedicine may reflect lower overall healthcare use, 35 – 37 negative experiences with the healthcare system, 38 and even differences in where they seek care. 39 , 40 Whether the difference in telemedicine use among Asian Americans can be explained by differences in preferences, experiences, or other factors is unclear and requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

Differences in Telemedicine, Emergency Department, and Hospital Utilization Among Nonelderly Adults with Limited English Proficiency Post-COVID-19 Pandemic: a Cross-Sectional Analysis

Chang,

Davis,

Berkman

2023

J GEN INTERN MED

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Background The unprecedented use of telemedicine during the COVID-19 pandemic provided an opportunity to examine its uptake among individuals with limited English proficiency (LEP). Objective To assess telemedicine use among nonelderly adults with LEP and the association between use of telehealth and emergency department (ED) and hospital visits. Design Cross-sectional study using the National Health Interview Survey (July 2020–December 2021) Participants Adults (18–64 years), with LEP (N=1488) or English proficiency (EP) (N=25,873) Main Measures Telemedicine, ED visits, and hospital visits in the past 12 months. We used multivariate logistic regression to assess (1) the association of English proficiency on having telemedicine visits; and (2) the association of English proficiency and telemedicine visits on having ED and hospital visits. Key Results Between July 2020 and December 2021, 22% of adults with LEP had a telemedicine visit compared to 35% of adults with EP. After controlling for predisposing, enabling, and need factors, adults with LEP had 20% lower odds of having a telemedicine visit than adults with EP (p=0.02). While English proficiency was not associated with ED or hospital visits during this time, adults with telemedicine visits had significantly greater odds of having any ED (aOR: 1.80, p<0.001) and hospital visits (aOR: 2.03, p<0.001) in the past 12 months. Conclusions While telemedicine use increased overall during the COVID-19 pandemic, its use remained much less likely among adults with LEP. Interventions targeting structural barriers are needed to address disparities in access to telemedicine. More research is needed to understand the relationship between English proficiency, telemedicine visits, and downstream ED and hospital visits.

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Section: Discussionmentioning

confidence: 99%

Differences in Telemedicine, Emergency Department, and Hospital Utilization Among Nonelderly Adults with Limited English Proficiency Post-COVID-19 Pandemic: a Cross-Sectional Analysis

Chang,

Davis,

Berkman

2023

J GEN INTERN MED

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“…Particularly, more research is needed to understand why while Asian English proficiency adults were less likely to forgo health care, Asian LEP adults were more likely to forgo health care than their White counterparts during the pandemic. While this finding likely partially reflects the differential levels of health care access and use between US-born and foreign-born Asian Americans, 28,29 it is unclear whether this difference arises from differences in care-seeking behavior or perceived need or risk.…”

Section: Discussionmentioning

confidence: 94%

Delayed and Forgone Health Care Among Adults With Limited English Proficiency During the Early COVID-19 Pandemic

Chang,

Davis,

Berkman

2023

Medical Care

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Background: Individuals with limited English proficiency (LEP) have long faced barriers in navigating the health care system. More information is needed to understand whether their care was limited further during the early period of the COVID-19 pandemic. Objective: To assess the impact of English proficiency on delayed and forgone health care during the early COVID-19 pandemic. Research Design: Multivariate logistic regression analysis of National Health Interview Survey data (July–December 2020; n=16,941). Outcomes were self-reported delayed and forgone health care because of cost or the COVID-19 pandemic. Delayed health care included medical, dental, mental health, and pharmacy care. Forgone health care also included care at home from a health professional. Results: A greater percentage of LEP adults reported delayed (49%) and forgone (41%) health care than English-proficient adults (40% and 30%, respectively). However, English proficiency was not significantly associated with delayed or forgone health care, after adjusting for demographic, socioeconomic, and health factors. Among LEP adults, multivariate models showed that being uninsured, having a disability, and having chronic conditions increased the risk of delaying and forgoing health care. LEP adults of Asian race and Hispanic ethnicity were also more likely to forgo health care while those with 65+ years were less likely to forgo health care. Conclusions: Adults with LEP were more likely to experience challenges accessing health care early in the pandemic. Delayed and forgone health care were explained by low socioeconomic status and poor health. These findings highlight how during a period of limited health resources, deficiencies in the health care system resulted in an already disadvantaged group being at greater risk of inequitable access to care.

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“…Other mechanisms such as access to services and even cultural values may be at play here. For example, research in other patient populations (e.g., Medicare fee-for-service enrollees) has found that among all racial/ethnic groups (including White populations), Asians Americans had the most favorable characteristics related to access to healthcare services, such as living in a Metropolitan area, living less than 2 miles from a hospital, and living with adequate physician availability (Kim et al, 2019). It is therefore possible that the ease of access to healthcare services made it more likely for parents of Asian American children with ADHD to take their injured child to a provider for both severe and minor injuries.…”

Section: Discussionmentioning

confidence: 99%

The Economic Burden of Injuries in Children With ADHD in the U.S. From 2011 to 2020

Shen,

Shi,

Gauthier

et al. 2023

J Atten Disord

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Objective: Few studies have examined the economic burden of and sociodemographic disparities in injuries on families of children with ADHD on a national scale. The objective of this study was to address these literature gaps. Methods: Data from 7,102 children with ADHD aged 5 to 17 years in the Medical Expenditure Panel Survey 2011 to 2020 were analyzed for national trends, annualized average, and sociodemographic disparities in injury-related medical expenditures among children with ADHD. Results: The national economic burden of injuries for children with ADHD has nearly doubled over the10-year period. These costs were covered by private insurance (62%), public insurance (29%), and families (9%). Asian race was associated with higher total and family expenditures while having low income and public insurance were associated with lower family expenditures. Conclusions: Families and society carry significant and increasing economic burdens related to injuries in children with ADHD. Sociodemographic disparities are substantial and of policy relevance.

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Racial and Ethnic Differences in Healthcare Utilization among Medicare Fee-For-Service Enrollees

Cited by 7 publications

References 4 publications

Differences in Telemedicine, Emergency Department, and Hospital Utilization Among Nonelderly Adults with Limited English Proficiency Post-COVID-19 Pandemic: a Cross-Sectional Analysis

Differences in Telemedicine, Emergency Department, and Hospital Utilization Among Nonelderly Adults with Limited English Proficiency Post-COVID-19 Pandemic: a Cross-Sectional Analysis

Delayed and Forgone Health Care Among Adults With Limited English Proficiency During the Early COVID-19 Pandemic

The Economic Burden of Injuries in Children With ADHD in the U.S. From 2011 to 2020

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