Bloomberg School of Public Health, Department of Health Policy and Management, Johns Hopkins University, 624 N. Broadway, Hampton House 441-B, Baltimore, MD, 21205, USA.
Center for Gerontology and Healthcare Research, Brown University School of Public Health, Box G-S121(6), 121 S. Main Street, Providence, RI, 02912, USA.
J Racial Ethn Health Disparities. 2019 Dec;6(6):1200-1207. doi: 10.1007/s40615-019-00621-9. Epub 2019 Jul 29.
Home- and community-based services (HCBS) provide support to individuals needing assistance with daily activities, like people with multiple sclerosis (MS) who often experience functional impairment. Research notes racial differences in HCBS utilization among people with MS, which may be attributed to state's relative amount of long-term service and support (LTSS) expenditures dedicated to HCBS (HCBS priority). As a first step in untangling this mechanism, we explored how HCBS priority may contribute to racial differences in service utilization. Using Medicaid claims data for a national cohort of dual eligibles with MS, we find state HCBS priority is associated with disparities in utilization-blacks and Hispanics receiving HCBS more often do so in low-priority states compared with whites. Findings indicate a need for additional research focusing on health equity to further examine effects on quality of life and health outcomes of individuals who would benefit from more generous HCBS policies, specifically determining whether minorities in low-HCBS states fare worse than those in high-priority states. Findings from the present study can help policymakers more effectively design HCBS programs for diverse individuals.
家庭和社区为基础的服务（HCBS）为需要日常活动支持的个人提供支持，例如多发性硬化症（MS）患者，他们经常经历功能障碍。研究指出，MS 患者在 HCBS 利用方面存在种族差异，这可能归因于各州用于 HCBS（HCBS 优先级）的长期服务和支持（LTSS）支出的相对数量。作为解开这一机制的第一步，我们探讨了 HCBS 优先级如何导致服务利用方面的种族差异。我们使用 Medicaid 索赔数据对全国 MS 双重资格患者队列进行分析，发现州 HCBS 优先级与利用方面的差异有关 - 与白人相比，黑人和西班牙裔患者在 HCBS 优先级较低的州获得 HCBS 的频率更高。研究结果表明，需要进一步进行关注健康公平的研究，以进一步检查对那些受益于更慷慨的 HCBS 政策的个体的生活质量和健康结果的影响，特别是确定低 HCBS 州的少数民族是否比高优先级州的情况更糟。本研究的结果可以帮助政策制定者更有效地为不同人群设计 HCBS 计划。
