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Assessing the difference in racial and ethnic disparities in access to and use of care between Traditional Medicare and Medicare Advantage
Objective Test whether racial‐ethnic disparities in the access and use of care differ between Traditional Medicare (TM) and Medicare Advantage (MA). Data Source Secondary data from the 2015–2018 Medicare Current Beneficiary Survey (MCBS). Study Design Measure Black‐White and Hispanic‐White dispariti...
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| Published in: | Health services research 2023-08, Vol.58 (4), p.914-923 |
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| creator | Gangopadhyaya, Anuj Zuckerman, Stephen Rao, Nikhil |
| description | Objective
Test whether racial‐ethnic disparities in the access and use of care differ between Traditional Medicare (TM) and Medicare Advantage (MA).
Data Source
Secondary data from the 2015–2018 Medicare Current Beneficiary Survey (MCBS).
Study Design
Measure Black‐White and Hispanic‐White disparities in access to care and use of preventive services within TM, within MA, and assess the difference‐in‐disparities between the two programs with and without controls for factors that could influence enrollment, access, and use.
Data Collection/Extraction
Pool 2015–2018 MCBS data and restrict to non‐Hispanic Black, non‐Hispanic White, or Hispanic respondents.
Principal Findings
Black enrollees have worse access to care relative to White enrollees in TM and MA, particularly for cost‐related measures such as not having problems paying medical bills (11–13 pp. lower for Black enrollees; p |
| doi_str_mv | 10.1111/1475-6773.14150 |
| format | article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10315374</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A760306727</galeid><sourcerecordid>A760306727</sourcerecordid><originalsourceid>FETCH-LOGICAL-c6730-b96e8b0017d47534c8adb76e3ca09efb5c5beeb744a67526f413f08b19ad2c973</originalsourceid><addsrcrecordid>eNqFk1Fv0zAQxyMEYmXwzBuKhIRAIp0dO3byhKpqbEhFk2A8W45zSTyldrGTjX0FPjVOO0qDKkgeIvt-98_Zd_8oeonRHIfnDFOeJYxzMscUZ-hRNNvvPI5mCGGeFDilJ9Ez728QQjnJ6dPohLC8oLQgs-jnwnvwXpsm7luIK13X4MAoiLWJnVRadrE0VQx9a7QKcb-RTvca_AhIpUJy3NstM3iIbR0r6SAuob8DMPG1k1XArQk6n6HS2-AI7xeL6laaXjbwPHpSy87Di4fvafTt4_n18jJZXV18Wi5WiWKcoKQsGOTleLQqHJVQlcuq5AyIkqiAusxUVgKUnFLJeJaymmJSo7zEhaxSVXByGn3Y6W6Gcg2VAtM72YmN02vp7oWVWkwjRreisbcCI4IzwmlQePug4Oz3AXwv1tor6DppwA5epDxnqEgZLgL6-i_0xg4u3EagcpJiVlCc_qEa2YHQprbhx2oUFQvOEEGMp2PhyRGqAQOhSmug1mF7ws-P8OGtYK3V0YR3k4TA9PCjb-TgvcgvVv8q5oFVtuugARE6trya8m8O-BZk17fedsM4G34Kvj8AyyHM5nZAvW7a3u9qmeBnO1w5672Det9IjMToETE6QoyOEFuPhIxXh_3f879NEQC2A-7C_dz_T09cnn_9slP-BblFGEA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2832169412</pqid></control><display><type>article</type><title>Assessing the difference in racial and ethnic disparities in access to and use of care between Traditional Medicare and Medicare Advantage</title><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><source>Wiley</source><source>PubMed Central</source><creator>Gangopadhyaya, Anuj ; Zuckerman, Stephen ; Rao, Nikhil</creator><creatorcontrib>Gangopadhyaya, Anuj ; Zuckerman, Stephen ; Rao, Nikhil</creatorcontrib><description>Objective
Test whether racial‐ethnic disparities in the access and use of care differ between Traditional Medicare (TM) and Medicare Advantage (MA).
Data Source
Secondary data from the 2015–2018 Medicare Current Beneficiary Survey (MCBS).
Study Design
Measure Black‐White and Hispanic‐White disparities in access to care and use of preventive services within TM, within MA, and assess the difference‐in‐disparities between the two programs with and without controls for factors that could influence enrollment, access, and use.
Data Collection/Extraction
Pool 2015–2018 MCBS data and restrict to non‐Hispanic Black, non‐Hispanic White, or Hispanic respondents.
Principal Findings
Black enrollees have worse access to care relative to White enrollees in TM and MA, particularly for cost‐related measures such as not having problems paying medical bills (11–13 pp. lower for Black enrollees; p < 0.05) and satisfaction with out‐of‐pocket costs (5–6 pp. lower; p < 0.05). We find no difference in Black‐White disparities between TM and MA. Hispanic enrollees have worse access to care relative to White enrollees in TM but similar access relative to White enrollees in MA. Hispanic‐White disparities in not delaying care due to cost and not reporting problems paying medical bills are narrower in MA relative to TM by about 4 pp (significant at the p < 0.05 level) each. We find no consistent evidence that Black‐White or Hispanic‐White differences in the use of preventive services differ between TM and MA.
Conclusions
Across the measures of access and use studied here, racial and ethnic disparities in MA are not substantially narrower than in TM for Black and Hispanic enrollees relative to White enrollees. For Black enrollees, this study suggests that system‐wide reforms are required to reduce existing disparities. For Hispanic enrollees, MA does narrow some disparities in access to care relative to White enrollees but, in part, because White enrollees do not do as well in MA as they do in TM.</description><identifier>ISSN: 0017-9124</identifier><identifier>ISSN: 1475-6773</identifier><identifier>EISSN: 1475-6773</identifier><identifier>DOI: 10.1111/1475-6773.14150</identifier><identifier>PMID: 36894493</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject><![CDATA[Access ; Access control ; access to care ; Aged ; Black or African American - statistics & numerical data ; Black People ; Comparative analysis ; Cultural differences ; Data collection ; Ethnic differences ; Ethnicity ; Extraction ; Government programs ; Health Equity ; Healthcare Disparities - ethnology ; Healthcare Disparities - statistics & numerical data ; Hispanic or Latino - statistics & numerical data ; Hispanic people ; Humans ; Medicare ; Medicare - statistics & numerical data ; Medicare Advantage ; Medicare Part C - statistics & numerical data ; Medicine, Preventive ; Methods ; preventive care ; Preventive health services ; Preventive Health Services - statistics & numerical data ; Preventive medicine ; racial and ethnic disparities in health care ; Racial Groups ; Racial inequality ; Surveys ; Traditional Medicare ; United States - epidemiology ; White - statistics & numerical data]]></subject><ispartof>Health services research, 2023-08, Vol.58 (4), p.914-923</ispartof><rights>2023 Health Research and Educational Trust.</rights><rights>COPYRIGHT 2023 Health Research and Educational Trust</rights><rights>2023 Health Research and Educational Trust</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c6730-b96e8b0017d47534c8adb76e3ca09efb5c5beeb744a67526f413f08b19ad2c973</citedby><cites>FETCH-LOGICAL-c6730-b96e8b0017d47534c8adb76e3ca09efb5c5beeb744a67526f413f08b19ad2c973</cites><orcidid>0000-0003-3127-0612</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315374/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315374/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,30999,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36894493$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gangopadhyaya, Anuj</creatorcontrib><creatorcontrib>Zuckerman, Stephen</creatorcontrib><creatorcontrib>Rao, Nikhil</creatorcontrib><title>Assessing the difference in racial and ethnic disparities in access to and use of care between Traditional Medicare and Medicare Advantage</title><title>Health services research</title><addtitle>Health Serv Res</addtitle><description>Objective
Test whether racial‐ethnic disparities in the access and use of care differ between Traditional Medicare (TM) and Medicare Advantage (MA).
Data Source
Secondary data from the 2015–2018 Medicare Current Beneficiary Survey (MCBS).
Study Design
Measure Black‐White and Hispanic‐White disparities in access to care and use of preventive services within TM, within MA, and assess the difference‐in‐disparities between the two programs with and without controls for factors that could influence enrollment, access, and use.
Data Collection/Extraction
Pool 2015–2018 MCBS data and restrict to non‐Hispanic Black, non‐Hispanic White, or Hispanic respondents.
Principal Findings
Black enrollees have worse access to care relative to White enrollees in TM and MA, particularly for cost‐related measures such as not having problems paying medical bills (11–13 pp. lower for Black enrollees; p < 0.05) and satisfaction with out‐of‐pocket costs (5–6 pp. lower; p < 0.05). We find no difference in Black‐White disparities between TM and MA. Hispanic enrollees have worse access to care relative to White enrollees in TM but similar access relative to White enrollees in MA. Hispanic‐White disparities in not delaying care due to cost and not reporting problems paying medical bills are narrower in MA relative to TM by about 4 pp (significant at the p < 0.05 level) each. We find no consistent evidence that Black‐White or Hispanic‐White differences in the use of preventive services differ between TM and MA.
Conclusions
Across the measures of access and use studied here, racial and ethnic disparities in MA are not substantially narrower than in TM for Black and Hispanic enrollees relative to White enrollees. For Black enrollees, this study suggests that system‐wide reforms are required to reduce existing disparities. For Hispanic enrollees, MA does narrow some disparities in access to care relative to White enrollees but, in part, because White enrollees do not do as well in MA as they do in TM.</description><subject>Access</subject><subject>Access control</subject><subject>access to care</subject><subject>Aged</subject><subject>Black or African American - statistics & numerical data</subject><subject>Black People</subject><subject>Comparative analysis</subject><subject>Cultural differences</subject><subject>Data collection</subject><subject>Ethnic differences</subject><subject>Ethnicity</subject><subject>Extraction</subject><subject>Government programs</subject><subject>Health Equity</subject><subject>Healthcare Disparities - ethnology</subject><subject>Healthcare Disparities - statistics & numerical data</subject><subject>Hispanic or Latino - statistics & numerical data</subject><subject>Hispanic people</subject><subject>Humans</subject><subject>Medicare</subject><subject>Medicare - statistics & numerical data</subject><subject>Medicare Advantage</subject><subject>Medicare Part C - statistics & numerical data</subject><subject>Medicine, Preventive</subject><subject>Methods</subject><subject>preventive care</subject><subject>Preventive health services</subject><subject>Preventive Health Services - statistics & numerical data</subject><subject>Preventive medicine</subject><subject>racial and ethnic disparities in health care</subject><subject>Racial Groups</subject><subject>Racial inequality</subject><subject>Surveys</subject><subject>Traditional Medicare</subject><subject>United States - epidemiology</subject><subject>White - statistics & numerical data</subject><issn>0017-9124</issn><issn>1475-6773</issn><issn>1475-6773</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><recordid>eNqFk1Fv0zAQxyMEYmXwzBuKhIRAIp0dO3byhKpqbEhFk2A8W45zSTyldrGTjX0FPjVOO0qDKkgeIvt-98_Zd_8oeonRHIfnDFOeJYxzMscUZ-hRNNvvPI5mCGGeFDilJ9Ez728QQjnJ6dPohLC8oLQgs-jnwnvwXpsm7luIK13X4MAoiLWJnVRadrE0VQx9a7QKcb-RTvca_AhIpUJy3NstM3iIbR0r6SAuob8DMPG1k1XArQk6n6HS2-AI7xeL6laaXjbwPHpSy87Di4fvafTt4_n18jJZXV18Wi5WiWKcoKQsGOTleLQqHJVQlcuq5AyIkqiAusxUVgKUnFLJeJaymmJSo7zEhaxSVXByGn3Y6W6Gcg2VAtM72YmN02vp7oWVWkwjRreisbcCI4IzwmlQePug4Oz3AXwv1tor6DppwA5epDxnqEgZLgL6-i_0xg4u3EagcpJiVlCc_qEa2YHQprbhx2oUFQvOEEGMp2PhyRGqAQOhSmug1mF7ws-P8OGtYK3V0YR3k4TA9PCjb-TgvcgvVv8q5oFVtuugARE6trya8m8O-BZk17fedsM4G34Kvj8AyyHM5nZAvW7a3u9qmeBnO1w5672Det9IjMToETE6QoyOEFuPhIxXh_3f879NEQC2A-7C_dz_T09cnn_9slP-BblFGEA</recordid><startdate>202308</startdate><enddate>202308</enddate><creator>Gangopadhyaya, Anuj</creator><creator>Zuckerman, Stephen</creator><creator>Rao, Nikhil</creator><general>Blackwell Publishing Ltd</general><general>Health Research and Educational Trust</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>N95</scope><scope>XI7</scope><scope>8GL</scope><scope>7QJ</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-3127-0612</orcidid></search><sort><creationdate>202308</creationdate><title>Assessing the difference in racial and ethnic disparities in access to and use of care between Traditional Medicare and Medicare Advantage</title><author>Gangopadhyaya, Anuj ; Zuckerman, Stephen ; Rao, Nikhil</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c6730-b96e8b0017d47534c8adb76e3ca09efb5c5beeb744a67526f413f08b19ad2c973</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Access</topic><topic>Access control</topic><topic>access to care</topic><topic>Aged</topic><topic>Black or African American - statistics & numerical data</topic><topic>Black People</topic><topic>Comparative analysis</topic><topic>Cultural differences</topic><topic>Data collection</topic><topic>Ethnic differences</topic><topic>Ethnicity</topic><topic>Extraction</topic><topic>Government programs</topic><topic>Health Equity</topic><topic>Healthcare Disparities - ethnology</topic><topic>Healthcare Disparities - statistics & numerical data</topic><topic>Hispanic or Latino - statistics & numerical data</topic><topic>Hispanic people</topic><topic>Humans</topic><topic>Medicare</topic><topic>Medicare - statistics & numerical data</topic><topic>Medicare Advantage</topic><topic>Medicare Part C - statistics & numerical data</topic><topic>Medicine, Preventive</topic><topic>Methods</topic><topic>preventive care</topic><topic>Preventive health services</topic><topic>Preventive Health Services - statistics & numerical data</topic><topic>Preventive medicine</topic><topic>racial and ethnic disparities in health care</topic><topic>Racial Groups</topic><topic>Racial inequality</topic><topic>Surveys</topic><topic>Traditional Medicare</topic><topic>United States - epidemiology</topic><topic>White - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gangopadhyaya, Anuj</creatorcontrib><creatorcontrib>Zuckerman, Stephen</creatorcontrib><creatorcontrib>Rao, Nikhil</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale Business Insights</collection><collection>Business Insights: Essentials</collection><collection>Gale In Context: High School</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Health services research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gangopadhyaya, Anuj</au><au>Zuckerman, Stephen</au><au>Rao, Nikhil</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessing the difference in racial and ethnic disparities in access to and use of care between Traditional Medicare and Medicare Advantage</atitle><jtitle>Health services research</jtitle><addtitle>Health Serv Res</addtitle><date>2023-08</date><risdate>2023</risdate><volume>58</volume><issue>4</issue><spage>914</spage><epage>923</epage><pages>914-923</pages><issn>0017-9124</issn><issn>1475-6773</issn><eissn>1475-6773</eissn><abstract>Objective
Test whether racial‐ethnic disparities in the access and use of care differ between Traditional Medicare (TM) and Medicare Advantage (MA).
Data Source
Secondary data from the 2015–2018 Medicare Current Beneficiary Survey (MCBS).
Study Design
Measure Black‐White and Hispanic‐White disparities in access to care and use of preventive services within TM, within MA, and assess the difference‐in‐disparities between the two programs with and without controls for factors that could influence enrollment, access, and use.
Data Collection/Extraction
Pool 2015–2018 MCBS data and restrict to non‐Hispanic Black, non‐Hispanic White, or Hispanic respondents.
Principal Findings
Black enrollees have worse access to care relative to White enrollees in TM and MA, particularly for cost‐related measures such as not having problems paying medical bills (11–13 pp. lower for Black enrollees; p < 0.05) and satisfaction with out‐of‐pocket costs (5–6 pp. lower; p < 0.05). We find no difference in Black‐White disparities between TM and MA. Hispanic enrollees have worse access to care relative to White enrollees in TM but similar access relative to White enrollees in MA. Hispanic‐White disparities in not delaying care due to cost and not reporting problems paying medical bills are narrower in MA relative to TM by about 4 pp (significant at the p < 0.05 level) each. We find no consistent evidence that Black‐White or Hispanic‐White differences in the use of preventive services differ between TM and MA.
Conclusions
Across the measures of access and use studied here, racial and ethnic disparities in MA are not substantially narrower than in TM for Black and Hispanic enrollees relative to White enrollees. For Black enrollees, this study suggests that system‐wide reforms are required to reduce existing disparities. For Hispanic enrollees, MA does narrow some disparities in access to care relative to White enrollees but, in part, because White enrollees do not do as well in MA as they do in TM.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>36894493</pmid><doi>10.1111/1475-6773.14150</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-3127-0612</orcidid></addata></record> |
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| identifier | ISSN: 0017-9124 |
| ispartof | Health services research, 2023-08, Vol.58 (4), p.914-923 |
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| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10315374 |
| source | Applied Social Sciences Index & Abstracts (ASSIA); Wiley; PubMed Central |
| subjects | Access Access control access to care Aged Black or African American - statistics & numerical data Black People Comparative analysis Cultural differences Data collection Ethnic differences Ethnicity Extraction Government programs Health Equity Healthcare Disparities - ethnology Healthcare Disparities - statistics & numerical data Hispanic or Latino - statistics & numerical data Hispanic people Humans Medicare Medicare - statistics & numerical data Medicare Advantage Medicare Part C - statistics & numerical data Medicine, Preventive Methods preventive care Preventive health services Preventive Health Services - statistics & numerical data Preventive medicine racial and ethnic disparities in health care Racial Groups Racial inequality Surveys Traditional Medicare United States - epidemiology White - statistics & numerical data |
| title | Assessing the difference in racial and ethnic disparities in access to and use of care between Traditional Medicare and Medicare Advantage |
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