Preventable Hospitalizations More Common for Black Patients

January 24, 2024 - Black Medicaid enrollees are more likely to experience a preventable hospitalization than their White counterparts, according to a new report, a trend that researchers at the Urban Institute said likely indicates poor patient access to care. hypothesized could be related to implicit bias and structural racism.

Researchers involved in the assessment also suggested that implicit bias and structural racism could be behind the poor patient access to outpatient primary care among Black Medicaid beneficiaries.

“These findings suggest a need to improve access to outpatient care to effectively manage chronic conditions,” Claire O’Brien, research analyst at the Urban Institute, said in a statement emailed to journalists. “Efforts to improve access to care for these groups in Medicaid would improve enrollees’ lives, reduce state and federal spending, and promote health equity within Medicaid.”

Preventable hospitalizations are hospitalizations that could have been avoided with adequate access to low-acuity care, care coordination, and chronic disease management. Any hospitalization is costly, but preventable hospitalizations are of key interest because they represent an opportunity to avoid high-cost care and can indicate the quality of outpatient care.

This latest analysis, completed in partnership with the Robert Wood Johnson Foundation, stratified preventable hospitalizations by race and Supplemental Security Income (SSI), which indicates the presence of a disability and low income. Certain people with disabilities and who meet some income criteria can qualify for Medicaid under SSI.

Across the 11 states the researchers could include in a race-stratified assessment, the team noted that Black people were more likely to experience a preventable hospitalization for either asthma/COPD, diabetes, or heart failure than their White counterparts.

This disparity was most pronounced for heart failure. More than one in 10 (12.7 percent) of Black people who were SSI-eligible had a preventable hospitalization for heart failure compared to 7.2 percent of SSI-eligible White people who experienced the same. Disparities were smaller for asthma/COPD and diabetes, although still present, the research indicated.

When looking only at differences between SSI-eligible folks and those who are not SSI-eligible, similar disparities emerge. People eligible for Medicaid through SSI were more likely to have a preventable hospitalization for any of the explored disease states compared to those who qualified for Medicaid through other criteria. This disparity was most pronounced with heart failure hospitalizations.

Fundamentally, preventable hospitalizations indicate a lapse in access to low-acuity, outpatient care, like primary care, as well as chronic disease management.

“Minimizing preventable hospitalizations improves population health and reduces costs,” Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, stated publicly.

“The data for heart failure are particularly concerning as they show high overall rates as well as large differences by race and disability status, suggesting that enrollees lack sufficient access to high-quality primary care, particularly enrollees that are Black and/or disabled,” Hempstead added.

However, these disparities are likely present because of added care access burdens uniquely felt by non-Hispanic Black people and those who are SSI-eligible.

SSI-eligible people, for example, may face added barriers due to their disabilities and potentially lower income.

Meanwhile, structural racism may be hampering outcomes for Black Medicaid enrollees. Racist policymaking may have impacted eligibility for certain federal programs. Meanwhile, the specter of implicit bias and discrimination in healthcare may have dissuaded care access for Black patients.

“These findings suggest a need to improve access to outpatient care to effectively manage chronic conditions, particularly for Medicaid enrollees with SSI eligibility and for Black enrollees with known heart conditions,” the researchers said in conclusion. “Efforts to improve access to care for these groups in Medicaid and reduce geographic variation would improve enrollee’s lives, reduce state and federal spending, and promote health equity within Medicaid.