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This Article Full Text Full Text (PDF) All Versions of this Article: AJPH.2004.050880v1 96/2/363    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Wong, S. T. Articles by Korenbrot, C. C. Search for Related Content PubMed PubMed Citation Articles by Wong, S. T. Articles by Korenbrot, C. C. Related Collections Health Care Facilities/Services Health Policy Access to Care Native Americans Rural Health

Sabrina T. Wong, PhD, RN, Chi Kao, PhD, MA, James A. Crouch, MPH and Carol C. Korenbrot, PhD

At time of the study, Sabrina T. Wong and Chi Kao were with the Institute for Health Policy Studies, University of California, San Francisco. James A. Crouch is with the California Rural Indian Health Board, Sacramento. Carol C. Korenbrot is with the Institute for Health Policy Studies, University of California, San Francisco, and the California Rural Indian Health Board.

Correspondence: Requests for reprints should be sent to Carol Korenbrot, Research Director, California Rural Indian Health Board, 4400 Auburn Blvd, 2nd floor, Sacramento, CA 95841. (e-mail: carol.korenbrot{at}ihs.gov).

Objectives. We determined differences in Medicaid service use and health care costs in a rural Indian Health Service (IHS) user population of American Indians and Alaska Natives as compared with Whites.

Methods. California Medicaid eligibility and claims files were linked to IHS user files to obtain a sample of Medicaid-eligible American Indian/Alaska Native users (n=7910). A random sample of Whites was matched for age, gender, aid category, length of eligibility, and county of residence (n=15075). We used generalized linear models to compare risk-adjusted use of resources—ambulatory visits, prescriptions, emergency room visits, hospitalizations, and costs—both adjusting and stratifying for dominant source of ambulatory visits.

Results. American Indians/Alaska Natives had significantly lower use of Medicaid-paid ambulatory visits, prescriptions, emergency room visits, and hospitalizations and lower associated costs than Whites. Medicaid-paid total costs and use of services were lower for those who predominantly used Indian health program clinics, as well as for those who predominantly used other sources of ambulatory care.

Conclusions. Barriers to receiving Medicaid services and payments exist for American Indians/Alaska Natives in the rural IHS-user population. If American Indians/Alaska Natives are to have Medicaid resources comparable to those of Whites, these barriers must be reduced.