Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA.
Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, Seoul, Republic of Korea.
Health Serv Res. 2023 Apr;58(2):303-313. doi: 10.1111/1475-6773.13977. Epub 2022 Apr 9.
Racial and ethnic minority enrollees in Medicare Advantage (MA) plans tend to be in lower-quality plans, measured by a 5-star quality rating system. We examine whether differential access to high-rated plans was associated with this differential enrollment in high-rated plans by race and ethnicity among MA enrollees.
The Medicare Master Beneficiary Summary File and MA Landscape File for 2016.
We first examined county-level MA plan offerings by race and ethnicity. We then examined the association of racial and ethnic differences in enrollment by star rating by controlling for the following different sets of covariates: (1) individual-level characteristics only, and (2) individual-level characteristics and county-level MA plan offerings.
DATA COLLECTION/EXTRACTION METHODS: Not applicable PRINCIPAL FINDINGS: Racial and ethnic minority enrollees had, on average, more MA plans available in their counties of residence compared to White enrollees (16.1, 20.8, 20.2, vs. 15.1 for Black, Asian/Pacific Islander, Hispanic, and White enrollees), but had fewer number of high-rated plans (4-star plans or higher) and/or more number of low-rated plans (3.5-star plans or lower). While racial and ethnic minority enrollees had lower enrollment in 4-4.5 star plans than White enrollees, this difference substantially decreased after accounting for county-level MA plan offerings (-9.1 to -0.5 percentage points for Black enrollees, -15.9 to -5.0 percentage points for Asian/Pacific Islander enrollees, and -12.7 to 0.6 percentage points for Hispanic enrollees). Results for Black enrollees were notable as the racial difference reversed when we limited the analysis to those who live in counties that offer a 5-star plan. After accounting for county-level MA plan offerings, Black enrollees had 3.2 percentage points higher enrollment in 5-star plans than White enrollees.
Differences in enrollment in high-rated MA plans by race and ethnicity may be explained by limited access and not by individual characteristics or enrollment decisions.
在医疗保险优势（MA）计划中，少数族裔和少数民族参保人往往参加质量评级为 5 星的计划，这表明他们参加的计划质量较低。我们通过 MA 参保人种族和族裔的评级高低来检验他们是否可以选择高质量计划。
2016 年医疗保险主受益人汇总文件和 MA 全景文件。
我们首先检查了按种族和族裔划分的县级 MA 计划提供情况。然后，我们通过控制以下不同组别的协变量来检验星级评级对参保人种族和族裔差异的影响：（1）仅个人特征；（2）个人特征和县级 MA 计划。
数据收集/提取方法：不适用
与白人参保人相比，少数民族参保人在其居住地的县级拥有更多的 MA 计划（黑人、亚太裔、西班牙裔和白人参保人分别为 16.1、20.8、20.2 和 15.1），但拥有更少数量的高评级计划（4 星或更高）和/或更多数量的低评级计划（3.5 星或更低）。虽然少数民族参保人比白人参保人更不愿意选择 4-4.5 星的计划，但在考虑到县级 MA 计划后，这种差异明显缩小（黑人参保人从-9.1 降至-0.5 个百分点，亚太裔参保人从-15.9 降至-5.0 个百分点，西班牙裔参保人从-12.7 降至 0.6 个百分点）。对于黑人参保人来说，结果尤其引人注目，因为当我们将分析仅限于居住在提供 5 星计划的县的参保人时，这种种族差异就会逆转。在考虑到县级 MA 计划后，黑人参保人选择 5 星计划的比例比白人参保人高出 3.2 个百分点。
种族和族裔之间在高质量 MA 计划的参保率差异可能是由于获得机会有限，而不是由于个人特征或参保决定造成的。
