Racial Disparities in the Quality of Care for Enrollees in Medicare Managed Care

JAMA. 2002 Mar 13;287(10):1288-94. doi: 10.1001/jama.287.10.1288.

Abstract

Context: Substantial racial disparities in the use of some health services exist; however, much less is known about racial disparities in the quality of care.

Objective: To assess racial disparities in the quality of care for enrollees in Medicare managed care health plans.

Design and setting: Observational study, using the 1998 Health Plan Employer Data and Information Set (HEDIS), which summarized performance in calendar year 1997 for 4 measures of quality of care (breast cancer screening, eye examinations for patients with diabetes, beta-blocker use after myocardial infarction, and follow-up after hospitalization for mental illness).

Participants: A total of 305 574 (7.7%) beneficiaries who were enrolled in Medicare managed care health plans had data for at least 1 of the 4 HEDIS measures and were aged 65 years or older.

Main outcome measures: Rates of breast cancer screening, eye examinations for patients with diabetes, beta-blocker use after myocardial infarction, and follow-up after hospitalization for mental illness.

Results: Blacks were less likely than whites to receive breast cancer screening (62.9% vs 70.9%; P<.001), eye examinations for patients with diabetes (43.6% vs 50.4%; P =.02), beta-blocker medication after myocardial infarction (64.1% vs 73.8%; P<.005), and follow-up after hospitalization for mental illness (33.2 vs 54.0%; P<.001). After adjustment for potential confounding factors, racial disparities were still statistically significant for eye examinations for patients with diabetes, beta-blocker use after myocardial infarction, and follow-up after hospitalization for mental illness.

Conclusion: Among Medicare beneficiaries enrolled in managed care health plans, blacks received poorer quality of care than whites.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • African Americans / statistics & numerical data*
  • Aged
  • Breast Neoplasms / prevention & control
  • Diabetic Retinopathy / prevention & control
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Health Services Accessibility
  • Health Services for the Aged / standards*
  • Health Services for the Aged / statistics & numerical data
  • Hispanic Americans / statistics & numerical data*
  • Humans
  • Male
  • Managed Care Programs / standards*
  • Managed Care Programs / statistics & numerical data
  • Mass Screening / statistics & numerical data
  • Medicare Part C / standards*
  • Mental Disorders / rehabilitation
  • Myocardial Infarction / drug therapy
  • Quality Indicators, Health Care*
  • Socioeconomic Factors
  • United States / epidemiology

Substances

  • Adrenergic beta-Antagonists