Asian American and Pacific Islander Provider and Community Concerns with Rapid Managed Care Growth

BACKGROUND: Minority communities are becoming increasingly concerned that the rapid growth of managed care activities will lead to a deterioration of their limited health care services and of the diminution of the primary health care providers. A generally expressed opinion among Asian and Pacific Islander Americans (APIAs) is that where there are under­represented physicians groups, especially those who are culturally competent and ethnically sensitive, any health care reform strategy to control cost by cutting program funds is likely to compound the problem of under­representation of the provider community, and would result in greater medically under­serviced areas and populations. In contrast, where there are culturally competent and ethnically sensitive physicians serving their communities, health care is more accessible and of better quality. Physicians and other health care providers working in under­served APIA areas are concerned with the loss of their patients to newly formed health maintenance organizations, the increased hassle of paperwork, the increased levels of patient care activities, and the disincentives and erosion of their financial base. In California, the number of managed care programs leads the nations. Moreover, in seventeen California counties, the Medicaid program is being streamlined under a managed care delivery system. The concern among API communities is the loss of access, availability and acceptability of care. Research and data collection on these issues need to be conducted to assess and evaluate the impact of managed care delivery on the health of these populations. METHODS: Information from literature reviews, data from community health centers, 1990 Census data compiled and analyzed by the Asian and Pacific Islander Center for Census Information and Services (ACCIS) program at the Asian and Pacific Islander American Health Forum, and personal communications were the sources of information for this presentation. FINDINGS: The provision of health care services will be more difficult as the managed care movement grows. The supply of physicians providing primary care to the APIA communities is expected to become more acute. The number of primary care physicians is not sufficient to meet the needs of the APIA communities. CONCLUSIONS: The delivery of medical services must be culturally competent and ethnically sensitive. Special interventions are suggested to improve access, acceptability, and appropriateness of health services for the APIA populations. A mentorship program, beginning in the states with the largest numbers of APIAs targeting high school, college, and post-graduate students is suggested as a method to heighten students' sense of social responsibility, and to create the desire and incentive to work in under­served APIA communities.