Racial Disparities in Use of Medicare Home Health Care Among Patients with Diabetes

Purpose: Health disparities are found among racial groups across many health services, but little is known about disparities in Medicare home health care (HHC). Due to the importance of HHC to diabetes patients, and consistent with efforts to better understand and minimize racial disparities in health service use, we examined whether and how racial disparities exist in HHC use in a national sample of Medicare patients with diabetes.

Methods: Medicare HHC claims were linked to Outcome and Assessment Information Set data in a 20% random sample of Medicare beneficiaries who completed HHC episodes in 2002. Inclusion criteria for this study were self reported identity as Caucasian, African-American, Hispanic, or Asian; and a primary HHC diagnosis of type II diabetes. HHC use measures were: number of visits and visits per week by nurses, physical therapists, home health aides, and all 6 Medicare HHC clinical disciplines combined.

Results: Racial distribution of the sample (n=9,838) was: 62% Caucasian, 22% African American, 12% Hispanic, and 3% Asian. Controlling for numerous health-related and sociodemographic covariates, compared to Caucasian patients: African-Americans received more home health aide visits but fewer visits per week from nursing, physical therapy, and all clinical disciplines combined; Hispanics received more nursing visits and more visits from all disciplines (all differences p<0.001); Asians received equivalent amounts of all types of HHC visits.

Conclusions: African-American Medicare HHC patients with diabetes received less skilled care and more unskilled care than Caucasians, suggesting disparities in the use of the Medicare HHC benefit for diabetes care.