Collection of Data on Race/Ethnicity and Language Proficiency of Providers | Page 2
Published Online: December 20, 2013
David R. Nerenz, PhD; Rita Carreón, BS; and German Veselovskiy, MS
The surveys were fielded by e-mailing an Excel-based questionnaire, the same approach that had been used in the 2008 survey. (In 2006, the survey was fielded by e-mailing an invitation to a web-based survey.) The AHIP staff sent several reminders to nonresponding plans. All submissions were checked for accuracy and consistency, and several plans were contacted again and asked to clarify their submissions or provide supplementary information. Of 250 plans, 127 (51%) responded to the 2010 survey, including 59 commercial (48% of eligible plans), 51 Medicaid (59%), and 17 Medicare plans (43%). The responding plans represent a total enrollment of 170 million individuals.
We calculated the proportions of health plans with specific characteristics of interest. The statistical analysis was done by using SPSS 16.0 (SPSS Inc, Chicago, Illinois). We conducted the statistical testing for the difference between binomial proportions by calculating the z scores and the corresponding P values. Because our sample included the large share of the population, the finite population correction was included in the significance testing. Because our sample included a large share of the population (>5% of operating health plans in the United States), the finite population correction factor was included in the siginificance testing. This technique takes into account the actual size of the population from which the sample has drawn.
Race/Ethnicity Data of Providers and Staff
Slightly fewer than half of the survey respondents in 2010 reported collecting data on race or ethnicity on any or all of the physicians or other clinicians in the provider network. The proportion of plans collecting these data did not vary markedly by plan type: 41% of commercial plans, 47% of Medicare plans, and 49% of Medicaid plans (45% overall). When weighted by plan membership size, these proportions rose to 53% in Medicaid plans, 74% in Medicare plans, and 58% in commercial plans, or 58% overall. This increase due to weighting indicates that larger plans were more likely to report collecting these data than smaller plans.
Overall, health plans in 2010 reported having race and ethnicity data on 47.3% of their network providers (unweighted data), or 12.8% when weighted by enrollment. The distinct difference in proportions in the unweighted versus weighted analyses suggests that smaller plans were more successful in obtaining race/ethnicity information on providers than were larger plans. Medicaid health plans were more likely to successfully obtain these data from providers than commercial and Medicare plans (37.7% vs 11.7% and 4.2%, weighted data).
Table 1 summarizes the reasons given by plans reporting the collection of race/ethnicity data on providers for doing that data collection. Assessing diversity of provider network and ensuring member access to “minority physicians” were the 2 reasons most frequently cited. (Plans could indicate more than 1 reason for data collection).
Approximately half of the plans that collected this information made it available to enrollees, and the proportion of plans making information available did not vary significantly by plan type—46% for commercial plans, 50% for Medicare plans, and 52% for Medicaid plans (49% overall). Those plans that did make information available to enrollees reported doing it through a health plan provider directory (89% of plans making information available to enrollees), through a health plan website (64%), or through interactions with customer service representatives (60%).
Languages Spoken by Providers/Staff
Table 2 shows the extent to which plans reported collection of data on language spoken for various types of plan employees or network providers. Because responding plans had the option of reporting on collection of these data for “all health plan staff” and/or specific staff in the framing of the response options, it is difficult to know whether collecting data on some specific classes of staff is truly done less frequently. Some plans outsource some or all of their behavioral care and/or disease care management, but the survey did not include questions on the extent of outsourcing practices.
In Table 3, responses to a question about testing for language proficiency of various types of plan employees or network providers are presented. In general, plans did not report doing formal testing of language proficiency for network providers and most types of plan staff. Customer service staff was the group most likely to be formally tested for language proficiency.
As was the case for information on race/ethnicity, information on languages spoken by plan staff and network providers was conveyed to members primarily through the plan website, the provider directory, other printed member materials, and interactions with customer service representatives.
Changes From Earlier Surveys
The proportion of health plans collecting data on race/ethnicity of providers did not change significantly from 2006 to 2010 (45.4% in 2006, 39.3% in 2008, and 45.2% in 2010).
In spite of the fact that the proportion of plans reporting collection of provider race/ethnicity data was essentially the same in 2006 and 2010, closer examination of the survey data suggested that some plans that had been collecting providers’ race/ethnicity data in 2006 abandoned the practice in subsequent years. There was a statistically significant decline, for example, in the data collection of race/ethnicity of providers for Medicaid plans: 77% collected data in 2006 but only 46% collected data in 2008 (z score = –4.62, P <.001). Table 4 shows the specific pattern of changes in plans’ collection and sharing of race/ethnicity data on providers among a subset of plans that responded both to the 2006 and 2010 surveys (n = 67). Among plans that had been collecting data in 2006, nearly as many stopped by 2010 (n = 15) as continued (n = 20). Perhaps more striking is the observation that, of the 21 plans (shown in first and second columns of Table 4, second row) that were sharing data on provider’s race/ethnicity with plan members in 2006, many more had stopped doing that by 2010 (n = 15) than continued (n = 6). We were not able to determine through this survey why such efforts were suspended.
PDF is available on the last page.