Impact of Limited Care for Patients with Chronic Disease

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Access Challenges

The barriers to MS care experienced by racial and ethnic populations can be attributed in part to low health literacy, limited education, low income and a lack of insurance coverage. (10) Results from the NARCOM study described earlier demonstrated that 29.3% of Black patients earned less than $15,000 annually, versus 19.5% of Latino patients and 14.3% of White patients. An income between $50,000 to $75,000 annually was earned by 16.0% of Black patients versus 23.2% of Latino and 27.7% of White patients. (17)

Regarding insurance coverage, fewer Black patients with MS had private insurance coverage than Latino and White patients (57.6% vs 65.8% and 72.3%, respectively). Medicaid covered 10.8% of Black patients versus 7.4% of Latino patients versus 3.7% of White patients. (17) A retrospective analysis conducted in 2012 claims data for patients with MS covered by commercial insurance (n = 18,269) and Medicaid insurance (n = 1715) revealed noteworthy health care discrepancies between the 2 groups. Overall, per-patient annual costs for MS care were similar; however, the Medicaid group had up to 5 times higher inpatient and emergency department (ED)–related costs—and a higher number of visits. During 2012, 21.5% of Medicaid patients and 6.7% of commercial patients visited the ED 1 or more times, and 6.9% of Medicaid patients and 1.6% of commercial patients had 1 or more inpatient admissions. (19)

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