Access to Medical Care Under Medicaid: Differentials by Race

The Medicaid program was designed to help correct for the unequal access to medical care by income and race in pre-1965 America. Previous evaluations of the program have claimed that on average the eligible poor have enjoyed considerable gains in access, but that the benefits of Medicaid have not been shared equally by blacks and whites. We reexamine the evidence on differential access by race early in the program (1969) and evaluate that claim for the mature program (1976). Our evaluation is conducted within the context of multivariate models of physician and hospital utilization designed to control for a variety of socioeconomic, health status, and resource supply characteristics. While earlier evaluations overstated the extent of racial differentials in 1969, blacks who were not chronically ill had significantly lower levels of ambulatory care—both within and outside of the South. Between 1969 and 1976 all race, region, and health status groups of nonelderly Medicaid recipients experienced increases in physician visits that far outpaced those of the entire nonelderly U.S. population. By 1976 blacks clearly achieved equality with whites in Medicaid ambulatory care use. The only statistically significant shortfall we find is in hospital utilization among Southern blacks in good health.