Ko Hansoo, Alsadah Ghaida, Gimm Gilbert
Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, USA.
J Gen Intern Med. 2024 Dec 20. doi: 10.1007/s11606-024-09252-1.
With more than half of all beneficiaries enrolled in Medicare Advantage (MA) plans, ensuring access to high-quality MA plans is a key concern for policymakers. Access to high-quality MA plans may be limited in certain areas if private insurers are not willing to offer high-quality MA plans in local areas with greater unmet health-related social needs.
This study examined the association of a market-level social vulnerability index (SVI) score with the number of high-quality MA plans.
This study conducted a retrospective cross-sectional study.
Our analysis included 3113 USA counties in 2020.
Our primary outcome measure, the availability of high-quality MA plans at the market level, was defined by counting the raw number of 5-star plans, plans with 4.5 or higher stars, and plans with 4 or higher stars. We also counted the number of all MA plans at the market level as an outcome measure to explore private insurers' market entry and participation decisions.
We found evidence that fewer high-quality MA plans are available in markets with greater unmet social needs (higher SVI scores). Compared to the least vulnerable markets, the most vulnerable markets had 1.5 fewer MA plans overall [95%CI -2.9, -0.1]. The most vulnerable markets also had 1.1 fewer 4 or higher star plans [95%CI -1.9, -0.3] than the least vulnerable markets. Furthermore, this negative association was concentrated in the southern region, which has a greater proportion of Black/African Americans in its market-level populations.
As historically marginalized groups are more likely to reside in markets with greater unmet social needs, disparities in access to high-quality MA plans may widen existing health disparities. Therefore, monitoring the availability of high-quality MA plans in areas with greater unmet social needs is needed to improve health equity for MA beneficiaries.
超过半数的医疗保险受益人参加了医疗保险优势（MA）计划，因此确保人们能够获得高质量的MA计划是政策制定者的一个关键关切点。如果私人保险公司不愿意在健康相关社会需求未得到满足情况更严重的地区提供高质量的MA计划，那么在某些地区获得高质量MA计划的机会可能会受到限制。
本研究考察了市场层面的社会脆弱性指数（SVI）得分与高质量MA计划数量之间的关联。
本研究进行了一项回顾性横断面研究。
我们的分析纳入了2020年美国的3113个县。
我们的主要结局指标，即市场层面高质量MA计划的可及性，通过计算五星级计划、四星半及以上星级计划和四星及以上星级计划的原始数量来定义。我们还计算了市场层面所有MA计划的数量作为一个结局指标，以探讨私人保险公司的市场进入和参与决策。
我们发现有证据表明，在社会需求未得到满足情况更严重（SVI得分更高）的市场中，高质量MA计划的数量更少。与最不脆弱的市场相比，最脆弱的市场总体上MA计划少1.5个[95%置信区间 -2.9，-0.1]。最脆弱的市场与最不脆弱的市场相比，四星及以上星级计划也少1.1个[95%置信区间 -1.9，-0.3]。此外，这种负相关集中在南部地区，该地区市场层面人口中黑人/非裔美国人的比例更高。
由于历史上被边缘化的群体更有可能居住在社会需求未得到满足情况更严重的市场中，获得高质量MA计划的差异可能会扩大现有的健康差距。因此，需要监测社会需求未得到满足情况更严重地区高质量MA计划的可及性，以改善MA受益人的健康公平性。
