Medicare as a catalyst for reducing health disparities

Health Affairs

Volumn 24, Issue 2, 2005, Pages 365-375

  Eichner, June ^a   Vladeck, Bruce C ^b  

^a National Academy of Social Insurance   (United States)

^b Ernst and Young   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

BENEFICENCE; HEALTH CARE ACCESS; HEALTH CARE DELIVERY; HEALTH CARE MANAGEMENT; HEALTH CARE NEED; HEALTH CARE ORGANIZATION; HEALTH CARE PERSONNEL; HEALTH CARE PLANNING; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH CARE SYSTEM; HEALTH INSURANCE; HEALTH SERVICES RESEARCH; HEALTH STATUS; HOSPITAL; HUMAN RIGHTS; MEDICAID; MEDICAL INFORMATION SYSTEM; MEDICAL TECHNOLOGY; MEDICARE; NEGRO; NURSING HOME; OUTCOMES RESEARCH; PHYSICIAN; POPULATION RESEARCH; PRIVATE PRACTICE; PROCESS DEVELOPMENT; PROSPECTIVE PAYMENT; REIMBURSEMENT; REVIEW; SOCIAL INSURANCE; UNITED STATES; UTILIZATION REVIEW;

CULTURAL DIVERSITY; HEALTH STATUS INDICATORS; HUMANS; MEDICARE; PROFESSIONAL COMPETENCE; QUALITY OF HEALTH CARE; SOCIAL JUSTICE; UNITED STATES;

EID: 17244378384     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.24.2.365     Document Type: Review

References (42)

1. U.S. House of Representatives, Committee on Ways and Means, 2004 Green Book (Washington: U.S. Government Printing Office, 2004), 2-146. In 2001, 98.3 percent of aged U.S. residents were enrolled in Medicare. People age sixty-five and older, or their spouses, who are U.S. citizens or legal residents of the United States for at least five years and who paid into Medicare for a minimum of forty fiscal quarters are eligible for premium-free Medicare Part A. People older than age sixty-five who do not have the required work history may purchase Part A (as well as Part B) coverage. Minorities and recent immigrants may be disadvantaged because they are less likely to have paid Medicare and Social Security taxes for the minimum number of fiscal quarters. For the race/ethnicity distribution of beneficiaries by age and disability categories, see Centers for Medicare and Medicaid Services, Program Information on Medicare, Medicaid, SCHIP, and Other Programs of the Centers for Medicare and Medicaid Services, June 2002, cms.hhs.gov/charts/series/sec3-b1-9.pdf (15 December 2004).
2. U.S. House of Representatives, Committee on Ways and Means, 2004 Green Book (Washington: U.S. Government Printing Office, 2004), 2-146. In 2001, 98.3 percent of aged U.S. residents were enrolled in Medicare. People age sixty-five and older, or their spouses, who are U.S. citizens or legal residents of the United States for at least five years and who paid into Medicare for a minimum of forty fiscal quarters are eligible for premium-free Medicare Part A. People older than age sixty-five who do not have the required work history may purchase Part A (as well as Part B) coverage. Minorities and recent immigrants may be disadvantaged because they are less likely to have paid Medicare and Social Security taxes for the minimum number of fiscal quarters. For the race/ethnicity distribution of beneficiaries by age and disability categories, see Centers for Medicare and Medicaid Services, Program Information on Medicare, Medicaid, SCHIP, and Other Programs of the Centers for Medicare and Medicaid Services, June 2002, cms.hhs.gov/charts/series/sec3-b1-9.pdf (15 December 2004).
3. B.D. Smedley, A.Y. Stith, and A.R. Nelson, eds., Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Washington: National Academies Press, 2002), 38-79.
4. E. Arias et al., Deaths: Final Data for 2001, National Vital Statistics Report 52, no. 3 (18 September 2003); and R. Sharma and H. Liu, Health and Health Care of the Medicare Population: Data from the 2000 Medicare Current Beneficiary Survey (Rockville, Md.: Westat, 2004), 51.
5. E. Arias et al., Deaths: Final Data for 2001, National Vital Statistics Report 52, no. 3 (18 September 2003); and R. Sharma and H. Liu, Health and Health Care of the Medicare Population: Data from the 2000 Medicare Current Beneficiary Survey (Rockville, Md.: Westat, 2004), 51.
6. Nevertheless, minority beneficiaries do not represent the larger absolute number of beneficiaries with these limitations. In fact, 2.5 million white beneficiaries lack supplemental insurance, compared with 1.3 million minority beneficiaries, and 11.1 million white beneficiaries have incomes under $15,000, compared with 4.3 million minority beneficiaries. Sharma and Liu, Health and Health Care, 29, 40.
7. S. Rosenbaum, "Racial and Ethnic Disparities in Healthcare: Issues in the Design, Structure, and Administration of Federal Healthcare Financing Programs Supported through Direct Public Funding," in Unequal Treatment, 664-698.
8. J. Ryan and N. Super, "Dually Eligible for Medicare and Medicaid: Two for One or Double Jeopardy?" National Health Policy Forum Issue Brief no. 794 (Washington: George Washington University, 30 September 2003).
9. Study panel members are Bruce Vladeck (chair), Joseph Betancourt, Daniel Bourque, Kathleen Buto, Nilda Chong, Marian Gornick, Rodney Hood, Charles Kahn III, Renée Landers, Maya Rockeymoore, Reed Tuckson, David Williams, and Rose Crum-Johnson (CMS liaison).
10. The study panel's final report is scheduled for release in January 2006.
11. U.S. Census Bureau, "Projections of the Total Resident Population by Five-Year Age Groups, Race, and Hispanic Origin with Special Age Categories: Middle Series, 2025 to 2045," 14 January 2000, www.census.gov/population/ projections/nation/summary/np-t4-f.txt (6 December 2004).
12. Sharma and Liu, Health and Health Care, 25.
13. Medicare Payment Advisory Commission, Report to the Congress: Applying Quality Improvement Standards in Medicare (Washington: MedPAC, 2002).
14. S.F. Jencks, E.D. Huff, and T. Cuerdon, "Change in the Quality of Care Delivered to Medicare Beneficiaries, 1998-1999 to 2000-2001," Journal of the American Medical Association 289, no. 3 (2003): 305-312.
15. J.E. Wennberg et al., "Use of Medicare Claims Data to Monitor Provider-Specific Performance among Patients with Severe Chronic Illness," Health Affairs, 7 October 2004, content.healthaffairs.org/cgi/content/abstract/ hlthaff.var.5 (6 December 2004).
16. Jencks et al., "Change in the Quality of Care"; D.R. Burwen et al., "National and State Trends in Quality of Care for Acute Myocardial Infarction between 1994-1995 and 1998-1999: The Medicare Health Care Quality Improvement Program," Archives of Internal Medicine 163, no. 12 (2003): 1430-1439; and T.A. Marciniak et al., "Improving the Quality of Care for Medicare Patients with Acute Myocardial Infarction: Results from the Cooperative Cardiovascular Project," Journal of the American Medical Association 279, no. 17 (1998): 1351-1357.
17. Jencks et al., "Change in the Quality of Care"; D.R. Burwen et al., "National and State Trends in Quality of Care for Acute Myocardial Infarction between 1994-1995 and 1998-1999: The Medicare Health Care Quality Improvement Program," Archives of Internal Medicine 163, no. 12 (2003): 1430-1439; and T.A. Marciniak et al., "Improving the Quality of Care for Medicare Patients with Acute Myocardial Infarction: Results from the Cooperative Cardiovascular Project," Journal of the American Medical Association 279, no. 17 (1998): 1351-1357.
18. Jencks et al., "Change in the Quality of Care"; D.R. Burwen et al., "National and State Trends in Quality of Care for Acute Myocardial Infarction between 1994-1995 and 1998-1999: The Medicare Health Care Quality Improvement Program," Archives of Internal Medicine 163, no. 12 (2003): 1430-1439; and T.A. Marciniak et al., "Improving the Quality of Care for Medicare Patients with Acute Myocardial Infarction: Results from the Cooperative Cardiovascular Project," Journal of the American Medical Association 279, no. 17 (1998): 1351-1357.
19. D.B. Smith, Health Care Divided: Race and Healing a Nation (Ann Arbor: University of Michigan Press, 1999).
20. S.L. Arday et al., "HCFA's Racial and Ethnic Data: Current Accuracy and Recent Improvements," Health Care Financing Review 21, no. 4 (2000): 107-116.
21. Centers for Medicare and Medicaid Services, "Seventh Scope Contract, Quality Improvement Organization Program Statement of Work," Version no. 011503-4A, www.cms.hhs.gov/qio/2t.pdf (6 December 2004).
22. CMS, Operational Policy Letter no. OPL 2001.133, 16 July 2001, cms.hhs.gov/healthplans/opl/opl133.pdf (15 December 2004).
23. Federal Register 65, no. 159 (16 August 2000): 50123-50125.
24. Part A providers are covered; Part B providers who only receive Medicare Part B payments are exempted. Those who receive other federal dollars, such as Medicaid or the State Children's Health Insurance Program (SCHIP), are required to comply with the guidance for all of the patients with limited English proficiency, including Medicare beneficiaries.
25. Title VI, 42 U.S.C., sec. 2000d states, "No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance." The courts have held that Title VI prohibits recipients of federal financial assistance from denying access to programs to people with limited English proficiency on the basis of their national origin.
26. M. van Ryn and J. Burke, "The Effect of Patient Race and Socio-Economic Status on Physicians' Perceptions of Patients," Social Science and Medicine 50, no. 6 (2000): 813-828; and K.A. Schulman et al., "The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization," New England Journal of Medicine 340, no. 8 (1999): 618-626.
27. M. van Ryn and J. Burke, "The Effect of Patient Race and Socio-Economic Status on Physicians' Perceptions of Patients," Social Science and Medicine 50, no. 6 (2000): 813-828; and K.A. Schulman et al., "The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization," New England Journal of Medicine 340, no. 8 (1999): 618-626.
28. Smedley et al., eds., Unequal Treatment.
29. C. Kane, "The Practice Arrangements of Patient Care Physicians, 2001," Physician Marketplace Report (Chicago: American Medical Association, 2004).
30. K.M. King and M. Schlesinger, eds., The Role of Private Health Plans in Medicare: Lessons from the Past, Looking to the Future (Washington: National Academy of Social Insurance, November 2003), 114-127.
31. R. Abelson, "Generous Medicare Payments Spur Specialty Hospital Boom," New York Times, 26 October 2003; and Henry J. Kaiser Family Foundation and American College of Cardiology Foundation, Racial/Ethnic Differences in Cardiac Care: The Weight of the Evidence (Menlo Park, Calif.: Kaiser Family Foundation, 2002).
32. R. Abelson, "Generous Medicare Payments Spur Specialty Hospital Boom," New York Times, 26 October 2003; and Henry J. Kaiser Family Foundation and American College of Cardiology Foundation, Racial/Ethnic Differences in Cardiac Care: The Weight of the Evidence (Menlo Park, Calif.: Kaiser Family Foundation, 2002).
33. T. Perez, "The Civil Rights Dimension of Racial and Ethnic Disparities in Health Status," in Unequal Treatment, 626-633.
34. P.B. Bach et al., "Primary Care Physicians Who Treat Blacks and Whites," New England Journal of Medicine 351, no. 6 (2004): 575-584.
35. Smith, Health Care Divided, 211-234; and D.B. Smith, "Disparities in Treatment and the Healthcare Struggle to End Racial Segregation of Care," Working Paper (Cambridge, Mass.: Harvard University Civil Rights Project, 2004).
36. Smith, Health Care Divided, 211-234; and D.B. Smith, "Disparities in Treatment and the Healthcare Struggle to End Racial Segregation of Care," Working Paper (Cambridge, Mass.: Harvard University Civil Rights Project, 2004).
37. U.S. Commission on Civil Rights, The Health Care Challenge: Acknowledging Disparity, Confronting Discrimination, and Ensuring Equality (Washington: U.S. Commission on Civil Rights, 1999).
38. 121 S. Ct. 1511 (2001).
39. M. Beach et al., Strategies for Improving Minority Healthcare Quality, Pub. no. AHRQ 04-E008-02 (Rockville, Md.: Agency for Healthcare Research and Quality, January 2004).
40. "Underserved" includes rural, as well as racial and ethnic minority group, beneficiaries.
41. QSource, QIO Efforts to Reduce Healthcare Disparities, 1999-2002 (Memphis, Tenn.: QSource, 2004). It could not document a reduction in statewide disparities, in part because the intervention happened only in selected counties and in part because the quality indicator performance of white beneficiaries also improved.
42. Smith, Health Care Divided.