RAND Corporation, Santa Monica, CA 90401, USA.
Med Care. 2013 Sep;51(9):823-31. doi: 10.1097/MLR.0b013e31829c8d77.
Although Medicare provides beneficiaries with primary access to the health care system, racial/ethnic disparities in health care experiences and preventive care are well documented in the Medicare population.
To investigate disease burden and its possible impact on racial/ethnic health disparities for measures of secondary and tertiary access to health care, such as access to health plan information, obtaining recommended care in a timely manner, and immunization.
A total of 355,874 beneficiaries over the age of 64 years who responded to the 2008 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.
We fit a series of linear, case-mix adjusted models predicting Medicare CAHPS measures of patient experience and immunization from race/ethnicity, a 0 to 6 count of disease burden, and their interaction.
Disparities between non-Hispanic whites and other racial/ethnic groups are largest among beneficiaries with no major health conditions. Disparities between whites and other racial/ethnic groups on getting care quickly and immunization are mitigated at higher levels of disease burden. Disparities persist at higher levels of disease burden for getting information from one's health plan.
Whites have better overall access to care than other beneficiaries with Medicare in the absence of major health conditions. Disparities in getting care quickly and immunizations are smaller among beneficiaries with greater disease burden, perhaps as a function of integration into the health care system gained through management of health issues. These results underscore the importance of outreach to minorities with low utilization and few or no major health conditions.
尽管医疗保险为受益人提供了对医疗保健系统的主要访问权限，但医疗保险人群中的医疗保健体验和预防保健方面的种族/民族差异已得到充分记录。
调查疾病负担及其对医疗保健二级和三级获得途径（如获得健康计划信息、及时获得推荐护理和免疫接种）的种族/民族健康差异的可能影响。
共有 355874 名年龄在 64 岁以上的受益人回应了 2008 年医疗保险消费者评估医疗保健提供者和系统（CAHPS）调查。
我们拟合了一系列线性、病例组合调整模型，从种族/民族、0 到 6 的疾病负担计数及其相互作用预测医疗保险 CAHPS 患者体验和免疫接种措施。
在没有主要健康状况的受益人中，非西班牙裔白人和其他种族/民族群体之间的差异最大。在快速获得护理和免疫接种方面，白人和其他种族/民族群体之间的差异在疾病负担水平较高时会减轻。在获得健康计划信息方面，疾病负担水平较高时，差异仍然存在。
在没有主要健康问题的情况下，白人比其他医疗保险受益人总体上获得更好的医疗服务。在快速获得护理和免疫接种方面，疾病负担较大的受益人的差异较小，这可能是通过管理健康问题融入医疗保健系统的结果。这些结果强调了向利用率低、没有或几乎没有主要健康问题的少数民族进行宣传的重要性。
