Satisfaction with Medicare coverage and overall healthcare among Black, Hispanic and White seniors enrolled in Medicare

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.