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Abstract #160158

Dolly A. John, MPH¹, Margaret Byrne, PhD², Iris I. Wei, DrPH³, Cayla R. Teal, PhD³, Beth A. Virnig, PhD⁴, and Robert O. Morgan, PhD³. (1) Dept. of Health Services, University of Washington School of Public Health and Community Medicine, Box 357660, Seattle, WA 98195, 832-798-6871, dajohn@u.washington.edu, (2) Dept. of Epidemiology and Public Health, University of Miami Miller School of Medicine, Highland Professional Building, Room 200J, 1801 N.W. 9th Avenue, Miami, FL 33101, (3) Houston Center for Quality of Care and Utilization Studies, Michael E. Debakey VA Medical Center and Baylor College of Medicine, 2002 Holcombe Blvd. (152), Houston, TX 77030, (4) Division of Health Policy & Management, University of Minnesota School of Public Health, 420 Delaware Street SE, MMC 729, Minneapolis, MN 55455

Background: Although numerous surveys assess the satisfaction of seniors with Medicare, racial/ethnic differences in satisfaction are rarely examined. Prior studies show that minorities delay seeking needed care, minority expectations and experiences of care may be different, and that satisfaction may serve an evaluative role as a reflection of expectations met, thereby influencing subsequent healthcare seeking behavior. Objective: We examined racial/ethnic variations in satisfaction with Medicare coverage and with overall healthcare, overall, and by gender, annual household income (≤ $10,000/yr., between $10,001 and $20,000/yr. and > $20,000/yr.), and Medicare program [Fee-For-Service (FFS) only, FFS with supplemental coverage or Medicare+Choice (M+C)]. Methods: We analyzed data collected from a population-based survey “2004 National Health and Health Services Use Survey” of seniors on Medicare. The survey sample (n=2997) was a stratified random sample drawn from counties with active M+C plans in 6 metropolitan areas and 3 non-metropolitan regions having adequate numbers of M+C and FFS enrollees in each of the racial/ethnic and gender groups. All bivariate and multivariate logistic regression analyses were weighted using the stratified sampling proportions. Results: 84% of White, 80% of Black and 84% of Hispanic seniors were very/somewhat satisfied with their Medicare coverage (p=.0749). However, compared to 93% of White seniors, 91% of Black and 86% of Hispanic seniors were very/somewhat satisfied with their overall healthcare (p=.0011). In sub-group analyses by gender, minority women were less likely to be very/somewhat satisfied with their overall healthcare than White women (p=.0272). Minority men were less likely to be very/somewhat satisfied with both their Medicare coverage and their overall healthcare than White men (p < .01). Minority seniors with incomes ≤ $10,000/yr. were more likely (p=.0266) while minority seniors with incomes between $10,001-$20,000/yr. were less likely (p=.0001) to be very/somewhat satisfied with their overall healthcare than White seniors in the same income category. Additionally, minority M+C enrollees were less likely to report being very/somewhat satisfied with their overall healthcare than White M+C enrollees (p=.0429). Multivariate analyses identifying the individual and system level predictors of both types of satisfaction will be presented. Preliminary results suggest that different factors predict the two types of satisfaction. Conclusions: More seniors report being satisfied with their overall healthcare than with their Medicare coverage. In general, minorities were less satisfied than whites, but minorities with lower incomes reported being more satisfied than Whites. Understanding the predictors of both types of satisfaction can help improve access to and delivery of timely, effective and patient-centered care to all seniors.

Learning Objectives:

• Articulate how satisfaction with healthcare coverage and healthcare can affect health services use and health.
• List 2 reasons why satisfaction measures are useful.
• Recognize that satisfaction with overall healthcare and with Medicare coverage varies with race/ethnicity.
• Discuss how 2 measures of satisfaction (satisfaction with Medicare coverage and satisfaction with overall healthcare) may be different.

Keywords: Medicare, Health Disparities

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.