Effect of ethnicity on denial of authorization for emergency department care by managed care gatekeepers

Robert A. Lowe, Sheetal Chhaya, Kathleen Nasci, Laurence J. Gavin, Kathy Shaw, Mark L. Zwanger, Joseph A. Zeccardi, William C. Dalsey, Stephanie B. Abbuhl, Harold Feldman, Jesse A. Berlin

Research output: Contribution to journalArticle

21 Scopus citations

Abstract

Objective: After a pilot study suggested that African American patients enrolled in managed care organizations (MCOs) were more likely than whites to be denied authorization for emergency department (ED) care through gatekeeping, the authors sought to determine the association between ethnicity and denial of authorization in a second, larger study at another hospital. Methods: A retrospective cohort design was used, with adjustment for triage score, age, gender, day and time of arrival at the ED, and type of MCO. Results: African Americans were more likely to be denied authorization for ED visits by the gatekeepers representing their MCOs even after adjusting for confounders, with an odds ratio of 1.52 (95% CI = 1.18 to 1.94). Conclusions: African Americans were more likely than whites to be denied authorization for ED visits. The observational study design raises the possibility that incomplete control of confounding contributed to or accounted for the association between ethnicity and gatekeeping decisions. Nevertheless, the questions that these findings raise about equity of gatekeeping indicate a need for additional research in this area.

Original languageEnglish (US)
Pages (from-to)259-266
Number of pages8
JournalAcademic Emergency Medicine
Volume8
Issue number3
DOIs
StatePublished - Jan 1 2001

Keywords

  • African Americans
  • Attitude of health personnel
  • Emergency medicine
  • Ethnicity
  • Health maintenance organizations
  • Health services accessibility
  • Race
  • Whites

ASJC Scopus subject areas

  • Emergency Medicine

Fingerprint Dive into the research topics of 'Effect of ethnicity on denial of authorization for emergency department care by managed care gatekeepers'. Together they form a unique fingerprint.

  • Cite this

    Lowe, R. A., Chhaya, S., Nasci, K., Gavin, L. J., Shaw, K., Zwanger, M. L., Zeccardi, J. A., Dalsey, W. C., Abbuhl, S. B., Feldman, H., & Berlin, J. A. (2001). Effect of ethnicity on denial of authorization for emergency department care by managed care gatekeepers. Academic Emergency Medicine, 8(3), 259-266. https://doi.org/10.1111/j.1553-2712.2001.tb01302.x