Can Medicaid payment and purchasing strategies advance health equity?: key considerations, limitations, lessons, and examples from four states
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Urban Institute research report
- Author(s):
- Allen, Eva H., author Willis, Carla, author
- Contributor(s):
- Health Policy Center (Urban Institute), issuing body.
- Publication:
- Washington, DC : Urban Institute, December 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Ethnic and Racial Minorities Health Care Reform Health Equity Health Policy Healthcare Disparities -- economics Managed Care Programs Medicaid -- economics Medicaid -- organization & administration Minnesota North Carolina Ohio Oregon
- Genre(s):
- Technical Report
- Abstract:
- The landmark 2003 report Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare brought national attention to shocking racial and ethnic disparities in access to and quality of health care. Among other findings, the study concluded that the way health care services are delivered and financed, such as through Medicaid, may contribute to racial and ethnic disparities in access to health care. Though disparities in access and quality of health care occur across the US health care system, Medicaid is the nation’s largest public health insurer, covering one in five US residents, who are disproportionately people from racial and ethnic minority groups. We do not have a complete understanding of disparities in the Medicaid program, largely due to the absence of consistent and complete data on members’ race and ethnicity, but available evidence suggests that Medicaid members from racial and ethnic minority groups experience more barriers to care and have worse health outcomes than white Medicaid members. Policy analysts have been increasingly calling on Medicaid to use available levers and authorities to reduce persistent racial and ethnic health disparities. Because of its large footprint in the US health care system and importance as a source of coverage for people at high risk of experiencing health disparities, Medicaid policies and initiatives have the potential for a big impact on advancing health equity. This report examines the potential of Medicaid payment and purchasing strategies to advance equity, such as by managed care contracting, benefit and delivery model design, payment reforms, and Section 1115 waiver demonstrations. Inspired by the Robert Wood Johnson Foundation, we broadly define equity as conditions under which every Medicaid member - regardless of their health status, geographic location, sexual orientation and gender identity, or demographic background - is able to access health care services, receive high quality and culturally effective health care, and achieve optimal health and well-being. Equity essentially requires holistic care that recognizes and addresses each person’s unique health care and social care needs. We analyzed published literature and conducted interviews with Medicaid policy experts and stakeholders in four states to understand how payment and purchasing strategies could promote equity in Medicaid. Minnesota and Ohio explicitly center health equity goals in their newly developed payment and purchasing strategies, while North Carolina’s and Oregon’s efforts predate the recent focus on health equity but have the potential to promote greater health equity by virtue of addressing systemic barriers to health. Across these four states, we identified several common themes and key considerations in developing effective purchasing and payment approaches for reducing health disparities in Medicaid.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-DC license. (More information)
- Extent:
- 1 online resource (1 PDF file (iv, 45 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918750488706676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918750488706676