Recorded presentation

Jennifer Uhrig, PhD¹, Jeffrey S. Laufenberg, MS², Celia R. Eicheldinger, MS², Shulamit Bernard, PhD³, and G. Gordon Brown, PhD². (1) Health, Social and Economics Research, RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, 919-541-6000, uhrig@rti.org, (2) Statistics Divsion, RTI International, 3040 Cornwallis Rd, Research Triangle Park, NC 27709, (3) Health Care Quality Program, RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709

Prior research has demonstrated that there are differences in access to health care services by race and ethnicity, even among those with health insurance. Given these disparities this study examines whether consumer reports and ratings of health care in fee-for-service Medicare vary by race/ethnicity, and to determine whether the consumer reports and ratings change over time.

We used data from the 2000-2002 National Medicare Fee-for-Service CAHPS surveys. The sample of beneficiaries was drawn from a sampling frame constructed from the CMS Enrollment Data Base. In each of the three years, the frame comprised over 30 million beneficiaries. The number of respondents and response rates for the surveys was 103,551 (64%) in 2000, 117,836 (68%) in 2001, and 122,955 (71%) in 2002, respectively. The combined analysis file contained 344,342 survey respondents. We calculated CAHPS ratings and composites for each racial and ethnic subgroup using the CAHPS 3.4 Survey and Reporting Kit macros. We used two sample tests for differences in proportions for all pairwise comparisons. We used the combined data set and compared all racial categories with white, and Hispanic with Non-Hispanic for each CAHPS rating and composite. We then stratified by year and compared responses within each racial/ethnic group to determine whether trends were present across years.Compared with whites, a larger percentage of all minority racial groups reported problems with getting needed care. Asians were more likely than whites to report problems or provide highest ratings for all measures except Rate Medicare. African-Americans were more likely to report problems getting needed care, however, they rate their health care very highly. American Indians/Alaska Natives reported worse experiences than did whites for getting needed care, communication and customer service. Hispanics were more likely than non-Hispanics to report problems getting needed care, respect, and care quickly. Reports and ratings were fairly stable among Hispanics, Non-Hispanics, whites, and African-Americans over the 3 years. Our findings show that statistically significant differences in experience and ratings among beneficiaries in FFS Medicare are associated with race and ethnicity. The findings point to a disconnect between studies that examine disparities in access, utilization and clinical quality versus those that examine patient reported experiences and ratings of care and providers. The consistent finding is that racial and ethnic minorities in the Medicare program experience more problems obtaining needed care and at the same time, provide higher levels of satisfaction with their doctor and their health plan.

Learning Objectives: After this session the participant will be able to

• Identify measures of quality from the perspective of the patient/consumer of health care services.
• Understand variation in experience and satisfaction by race and ethnicity
• Understand differences among Medicare beneficiaries in ratings of health care services
• Understand trends among Medicare fee for service beneficiaries in ratings of Medicare and how these differ by race and ethnicity

Keywords: Medicare, Minority Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation