Health Policy Center, Urban Institute Health Policy Center, 500 L'Enfant Plaza SW, Washington, DC, 20024, USA.
Health Serv Res. 2023 Aug;58(4):914-923. doi: 10.1111/1475-6773.14150. Epub 2023 Mar 25.
Test whether racial-ethnic disparities in the access and use of care differ between Traditional Medicare (TM) and Medicare Advantage (MA).
Secondary data from the 2015-2018 Medicare Current Beneficiary Survey (MCBS).
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.
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.
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.
测试在传统医疗保险（TM）和医疗保险优势计划（MA）中，医疗保健的可及性和使用方面是否存在种族差异。
2015-2018 年医疗保险当前受益人调查（MCBS）的二级数据。
在 TM 和 MA 内衡量黑人-白人以及西班牙裔-白人在获得医疗服务和使用预防服务方面的差异，并评估在控制可能影响参保、获得和使用的因素的情况下，两个计划之间差异的差异。
数据收集/提取：汇总 2015-2018 年 MCBS 数据，并限制为非西班牙裔黑人、非西班牙裔白人或西班牙裔受访者。
与 TM 和 MA 中的白人参保人相比，黑人参保人在获得医疗服务方面存在更大的困难，尤其是在与费用相关的方面，例如没有支付医疗费用的问题（黑人参保人低 11-13 个百分点；p<0.05）和对自付费用的满意度（低 5-6 个百分点；p<0.05）。我们没有发现 TM 和 MA 之间的黑人-白人差异。与 TM 中的白人参保人相比，西班牙裔参保人在获得医疗服务方面存在更大的困难，但在 MA 中与白人参保人相比，他们的获得医疗服务的机会相似。与 TM 相比，MA 中因费用而延迟医疗和不报告支付医疗费用问题的西班牙裔-白人差距缩小了约 4 个百分点（在 p<0.05 水平上具有统计学意义）。我们没有发现任何一致的证据表明，在 TM 和 MA 中，黑人-白人或西班牙裔-白人在预防服务使用方面的差异存在差异。
在所研究的获得和使用措施方面，与白人参保人相比，黑人参保人和西班牙裔参保人在 MA 中的种族和族裔差异在 TM 中并没有明显缩小。对于黑人参保人来说，这项研究表明需要进行系统范围的改革来减少现有的差异。对于西班牙裔参保人来说，MA 确实缩小了与白人参保人在获得医疗服务方面的一些差距，但部分原因是白人参保人在 MA 中的表现不如在 TM 中好。
