Inquiries and Inequities in managed Care
In a time when health care is one of the most urgent issues in the U.S. political spectrum, Keith Elder, Ph.D. graduate from the UMBC Policy Sciences (POSI) Graduate Program, is examining the tough questions surrounding our nation’s health care system.
Elder’s dissertation examines the racial disparities in managed care between majority and minority physicians. Specifically, it looks at health care contracts between physicians and organizations (such as HMOs) and attempts to determine if there is any connection between termination or denial of contracts and ethnicity.
“Patient demographics impact the rate of contract denials and terminations,” says Elder. “The greater the percentage of Latino and African American patients a physician serves, the higher the probability that physician will have a contract denied. The larger the percentage of Asian patients a physician sees, the higher the probability the physician will have a contract terminated.”
“After examining certain economic market level variables, the differences still exist. Some may look to other explanations for these differences in rate of contract denial and termination – namely, discrimination,” Elder says. Nancy Miller, assistant professor of policy sciences, corroborates Elder’s results, stating that they “offer evidence that requires serious reflection and action on the part of policy makers.”
Elder’s research draws data from the Maryland Physician Survey developed and conducted by the Center for Health Program Development and Management at UMBC. He drew from a sample size of about 1200 people. Elder will present his research at a symposium the center is holding March 26, The Effect of Managed Care on Minority Physicians and Socially Vulnerable Populations in Maryland: Data Findings and Policy Alternatives.
Unfortunately, the inequity that Elder identified in his research is not a new pattern in health care. “Minority physicians have reported inequities for years,” says Elder. In a 1994 survey of minority physicians, Elder says that “over 90 percent believed that they had experienced some form of discrimination. The same physicians believed that any health care reform would place them at a disadvantage in the managed care selection process.”
In addition to the Policy Sciences faculty, UMBC President Freeman Hrabowski has also been of great help to Elder: “He’s always given me support,” says Elder. “He gave me direction in how to plan for my dissertation defense, personal insights, told me what research opportunities I should be involved in. He wanted to make sure when I left here that I was ready for every opportunity that crossed my radar.”
Elder graduated from UMBC last fall and is currently doing research analysis for the POSI program. Next semester, he will begin a position as assistant professor in the School of Public Health at the University of South Carolina. While he will teach a university course, he also plans to spend a lot of time pursuing his research interests: “I definitely hope to further examine aspects of managed care and racial disparity,” states Elder.