Disparities Research Unit, Massachusetts General Hospital.
Departments of Medicine.
Med Care. 2022 Nov 1;60(11):806-812. doi: 10.1097/MLR.0000000000001768. Epub 2022 Aug 26.
The aim was to assess the magnitude of health care disparities in treatment for substance use disorder (SUD) and the role of health plan membership and place of residence in observed disparities in Medicaid Managed Care (MMC) plans in New York City (NYC).
Medicaid claims and managed care plan enrollment files for 2015-2017 in NYC.
We studied Medicaid enrollees with a SUD diagnosis during their first 6 months of enrollment in a managed care plan in 2015-2017. A series of linear regression models quantified service disparities across race/ethnicity for 5 outcome indicators: treatment engagement, receipt of psychosocial treatment, follow-up after withdrawal, rapid readmission, and treatment continuation. We assessed the degree to which plan membership and place of residence contributed to observed disparities.
We found disparities in access to treatment but the magnitude of the disparities in most cases was small. Plan membership and geography of residence explained little of the observed disparities. One exception is geography of residence among Asian Americans, which appears to mediate disparities for 2 of our 5 outcome measures.
Reallocating enrollees among MMC plans in NYC or evolving trends in group place of residence are unlikely to reduce disparities in treatment for SUD. System-wide reforms are needed to mitigate disparities.
评估在纽约市（NYC）医疗补助管理式医疗（MMC）计划中，物质使用障碍（SUD）治疗方面的医疗保健差异程度，以及健康计划成员身份和居住地在观察到的差异中的作用。
NYC 2015-2017 年的医疗补助索赔和管理式医疗计划参保文件。
我们研究了在 2015-2017 年期间，在管理式医疗计划中首次参保的 SUD 患者在参保后的前 6 个月内的服务差异。一系列线性回归模型量化了种族/民族在 5 个结果指标方面的治疗差异：治疗参与、接受心理社会治疗、戒断后的随访、快速再入院和治疗延续。我们评估了计划成员身份和居住地对观察到的差异的贡献程度。
我们发现治疗机会存在差异，但在大多数情况下，差异的幅度很小。计划成员身份和居住地的地理位置对观察到的差异解释不大。一个例外是亚裔美国人的居住地地理位置，这似乎对我们 5 个结果指标中的 2 个指标的差异起到了中介作用。
在 NYC 的 MMC 计划中重新分配参保人或不断变化的团体居住地趋势不太可能减少 SUD 治疗方面的差异。需要进行全系统改革以减轻差异。
