Medicaid's impact on access to and utilization of health care services among racial and ethnic minority children

Objectives: Since the early 1990s there has been an increasing awareness of social and ethnic inequity in health and for the last few years there has also been an increasing focus on disparities in the quality of health services to ethnic minority groups. The aim of this review was to collect and summarise in a systematic and transparent manner the effect of interventions to improve health care services for ethnic minorities.<br />Methods: We searched several medical databases for systematic reviews and randomised controlled trials. Two researchers independently screened for and selected studies, assessed risk of bias, extracted data and graded the quality of the evidence for each outcome in the included studies. The analysis was done qualitatively by describing studies and presenting them in tables.<br />Results: We included 19 primary studies. The interventions were targeted at reducing clinical, structural and organisational barriers against good quality health care services. Eight studies examined the effect of educational interventions in improving outcomes within cross-cultural communication, smoking cessation, asthma care, cancer screening and mental health care. In six comparisons the effect of reminders for improving health care services and patient outcomes within cancer screening and diabetes care was examined. Two studies compared professional remote interpretation services to traditional interpretation services, two studies compared ethnic matching of client and therapist and two studies examined the effect of providing additional support in the form of more personnel in the treatment of diabetes and kidney transplant patients. Most patients were African-Americans and Latin-Americans and all ages were represented.<br />Conclusions: Educational interventions and electronic reminders to physicians may in some contexts improve health care and health outcomes for minority patients. The quality of the evidence varied from low to very low. The quality of available evidence for the other interventions was too low to draw reliable conclusions. We found no studies that only included young patients, but we suggest that interventions targeted at health personnel or health organisations may be applicable regardless of the age of the patient population. This review reveals that the evidence for interventions to improve health care for minorities is sparse and generally of low quality.

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Mental Health and Disabilities: What We Know About Racial and Ethnic Minority Children

Annual Review of Nursing Research ◽

10.1891/0739-6686.22.1.265 ◽

2004 ◽

Vol 22 (1) ◽

pp. 265-281 ◽

Cited By ~ 1

Author(s):

MARY LOU DE LEON SIANTZ ◽

BETTE R. KELTNER

Keyword(s):

Mental Health ◽

Ethnic Minority ◽

Mental Health Problems ◽

Health Indicators ◽

The United States ◽

Health Problems ◽

Nursing Research ◽

Minority Children ◽

Ethnic Minority Children ◽

Racial And Ethnic Minority

The recognition that children and adolescents suffer from mental health problems and disabilities is a recent phenomenon, not arising until the late 19th century. Because of the increasing numbers and importance of ethnic minority children and youth to the vitality of the United States, their mental health and disabilities can no longer be overlooked. Mental health is paramount for fostering social integration, unity, and inclusiveness within and between ethnic groups. Thus the significance of changing demographics and the disparity in mental health indicators make this a key issue for the future. Nursing research in this area has been limited, in spite of the fact that mental health problems and disabilities exert a disproportionate negative effect on racial and ethnic minority children (NIMH, 2001a). The purpose of this chapter is to critique the available nursing research on mental health and disabilities in racial and ethnic minority children, including how such research has been conceptualized, conducted, and interpreted.

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