Impact of Limited Care for Patients with Chronic Disease
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)
