The effect of insurance type on racial disparities in access to hyperactive retroviral therapy (HAART)

Increasingly, government is relying on the managed care sector to provide coverage for the Medicaid population as a cost-containment mechanism and to potentially increase access. This study examines the effects Medicaid managed care (MC) on racial variation in access to care for patients living with HIV/AIDS in the US.; The dependent variable is exposure to Hyperactive Retroviral Therapy (HAART). Three sets of independent variables are used to reflect the components of the Behavioral Model of Health Services Utilization: enabling, predisposing, and need factors. The study uses Logistic Regression as a means of testing the relationship between the response and predictor variables. The two main regression models examine race effects, and race and insurance interaction effects on access to treatment. This study uses the HIV Cost and Services Utilization Study (HCSUS) data set, and is limited to 862 Black and White Medicaid enrollees in 1996.; The findings indicate that compared to their white counterparts, black HIV/AIDS patients in both FFS and MC experienced lower probabilities of access to standard HAART treatment. Disparities in access to care remained even after adjusting for all possible confounders. The effect of Managed Care at reducing racial differences in access to care was not statistically significant.; This study suggests that African Americans still face barriers in access to care, even after Medicaid has assured financial access. Furthermore, the study suggests that managed care does not eliminate racial differences in access to care for HIV/AIDS patients.; Discussed are recommendations and policy implications for access to care for black HIV/AIDS patients: (1) As the largest single payer of direct medical services to HIV/AIDS patients, the role of Medicaid in providing adequate access to care for vulnerable populations needs to be re-examined. (2) Policy makers interested in addressing access to care barriers need to reexamine current incentives aimed at improving access care for HIV/AIDS patients. This is especially important given the rising cost of HIV/AIDS treatment, and the incidence of the virus among African American communities.