Abstract
Objectives: Racial differences in health status and use of health services persist in the United States and are not completely explained by differences in socioeconomic status. This study examines differences in use of health services between White and African American children enrolled in Medicaid, controlling for other factors that affect service use. We make comparisons for use of primary preventive services, diagnosis and treatment of selected common childhood illnesses, and Medicaid expenditures. Methods: We linked Medicaid enrollment records, Medicaid paid claims data, and data on use of child WIC services to birth certificates for NorthCarolina children born in 1992 to measure use of health services and Medicaid expenditures by race for children ages 1, 2, 3, and 4. Logistic and Tobit regression models were used to estimate the independent effect ofrace, controlling for other variables such as low birth weight, WICparticipation, and mother's age, education, and marital status. Since allchildren enrolled in Medicaid are in families of relatively low income, racial differences in socioeconomic status are partially controlled.Results: African American children had consistently lower Medicaidexpenditures and lower use of health servicesthan did White children,after statistically controlling for other maternal and infantcharacteristics that affect health service use, including child WICparticipation. For example, total annual Medicaid expenditures were $207–303 less for African American children than for White children,controlling for other variables. African America children were significantly less likely to receive well-child and dental services than were White children. Conclusions: African American children enrolled in Medicaid use healthservices much less than White children, even when controlling forsocioeconomic status and other factors that affect service use. Linkingstate administrative databases can be a cost-effective way of addressingimportant issues such as racial disparities in health service use.
Similar content being viewed by others
References
Peterson ED, Shaw LK, DeLong ER, Pryor DB, Califf RM, Mark DB. Racial variation in the use of coronary-revascularization procedures. N Engl J Med 1997;336:480–6.
Whittle J, Conigliaro J, Good CB, Lofgren RP. Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system. N Engl J Med 1993;329:621–7.
Ayanian JZ, Udvarhelyi S, Gatsonis CA, Pashos CL, Epstein AM. Racial differences in the use of revascularization procedures after coronary angiography. JAMA 1993;269:2642–6.
Peterson ED, Wright SM, Daley J, Thibault GE. Racial variation in cardiac procedure use and survival following acute myocardial infarction in the Department of Veteran Affairs. JAMA 1994;271:1175–80.
Ford ES, Cooper RS. Racial/ethnic differences in health care utilization of cardiovascular procedures: A review of the evidence. Health Serv Res 1995;30:237–52.
Ronsaville DS, Hakim RB. Well child care in the United States: Racial differences in compliance with guidelines. Am J Public Health 2000;90:1436–43.
Newacheck PW, Hughes DC, Stoddard JJ. Children's access to primary care: Differences by race, income, and insurance status. Pediatrics 1996;97:26–32.
Weinick RM, Krauss NA. Racial/ethnic differences in children's access to care. Am J Public Health 2000;90:1771–4.
Zito JM, Safer DJ, dosReis S, Riddle MA. Racial disparity in psychotropic medications prescribed for youths with Medicaid insurance in Maryland. J Am Acad Child Adolesc Psychiatry 1998;37:179–84.
Newacheck PW, Stoddard JJ, McManus M. Ethnocultural variations in the prevalence and impact of childhood chronic conditions. Pediatrics 1993;91:1031–9.
Lieu TA, Newacheck PW, McManus MA. Race, ethnicity, and access to ambulatory care among U.S. adolescents. Am J Public Health 1993;83:960–5.
Krieger N. Analyzing socioeconomic and racial/ethnic patterns in health and health care. Am J Public Health 1993;83:1086–7.
Freeman H, Payne R. Racial injustice in health care. N Engl J Med 2000;342:1045–7.
Thomas SB. The color line: Race matters in the elimination of health disparities. Am J Public Health 2001;91:1046–8.
Fullilove MT. Comment: Abandoning ‘race’ as a variable in public health research—An idea whose time has come. Am J Public Health 1998;88:1297–8.
Buescher PA, Horton SJ, Devaney BL, Roholt SJ, Lenihan AJ, Whitmire JT, Kotch JB. Child participation in WIC: Medicaid costs and use of health care services. Am J Public Health 2003;93:145–50.
Mofidi M, Rozier RG, King RS. Problems with access to dental care for Medicaid-insured children: What caregivers think. Am J Public Health 2002;92:53–8.
Gergen PJ, Mullally DI, Evans R. National survey of prevalence of asthma among children in the United States, 1976 to 1980. Pediatrics 1988;81:1–7.
Gerstman BB, Bosco LA, Tomita DK, Gross TP, Shaw MM. Prevalence and treatment of asthma in the Michigan Medicaid patient population younger than 45 years, 1980–1986. J Allergy Clin Immunol 1989;83:1032–9.
Buescher PA, Jones-Vessey K. Using Medicaid data to estimate state-and county-level prevalence of asthma among low-income children. Matern Child Health J 1999;3:211–6.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Buescher, P.A., Horton, S.J., Devaney, B.L. et al. Differences in Use of Health Services Between White and African American Children Enrolled in Medicaid in North Carolina. Matern Child Health J 7, 45–52 (2003). https://doi.org/10.1023/A:1022541617877
Issue Date:
DOI: https://doi.org/10.1023/A:1022541617877