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Racial and Ethnic Disparities in Hospital-Based Care Among Dual Eligibles Who Use Health Centers
Journal article   Open access   Peer reviewed

Racial and Ethnic Disparities in Hospital-Based Care Among Dual Eligibles Who Use Health Centers

Brad Wright, Jill Akiyama, Andrew J. Potter, Lindsay M. Sabik, Grace G. Stehlin, Amal N. Trivedi and Fredric D. Wolinsky
Health equity, Vol.7(1), pp.9-18
01/01/2023
DOI: 10.1089/heq.2022.0037
PMCID: PMC9892926
PMID: 36744239
url
https://doi.org/10.1089/heq.2022.0037View
Published (Version of record) Open Access

Abstract

ethnic disparities in this population have not been widely studied. We examined the extent of racial and ethnic disparities in hospital-based care among duals using health centers and the degree to which disparities occur within or between health centers. Methods: We used 2012–2018 Medicare claims and health center data to model emergency department (ED) visits, observation stays, hospitalizations, and 30-day unplanned returns as a function of race and ethnicity among dual eligibles using health centers. Results: In rural and urban counties, age-eligible Black individuals had more ED visits (7.9 [4.0, 11.7] and 13.7 [10.0, 17.4] per 100 person-years) and were more likely to experience an unplanned return (1.4 [0.4, 2.4] and 1 [0.4, 1.6] percentage points [pp]) than White individuals, but were less likely to be hospitalized (−3.3 [−3.9, −2.8] and −1.2 [−1.6, −0.9] pp). In urban counties, age-eligible Black individuals were 1.2 [0.9, 1.5] pp more likely than White individuals to have observation stays. Other racial and ethnic groups used the same or less hospital-based care than White individuals. Including state and health center fixed effects eliminated Black versus White disparities in all outcomes, except hospitalization. Results were similar among disability–eligible duals. Conclusion: Racial and ethnic disparities in hospital-based care among dual eligibles are less common within than between health centers. If health centers are to play a more central role in eliminating racial and ethnic health disparities, these differences across health centers must be understood and addressed.

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