Racial/ethnic Disparities in Medicare Part D Experiences

Published in: Medical Care, v. 50, no. 11, suppl. 3, Nov. 2012, p. S40-S47

Posted on RAND.org on October 29, 2012

by Amelia Haviland, Marc N. Elliott, Robert Weech-Maldonado, Katrin Hambarsoomian, Nathan Orr, Ron D. Hays

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Research Question

  1. Are there racial/ethnic differences in Medicare beneficiary experiences with Medicare Part D prescription drug coverage?

OBJECTIVE: To examine racial/ethnic differences in Medicare beneficiary experiences with Medicare Part D prescription drug (PD) coverage. DATA SOURCES/STUDY SETTING: 2008 Consumer Assessment of Health Care Providers and Systems survey of U.S. Medicare beneficiaries. STUDY DESIGN: Surveys were administered by mail with phone follow-up to a nationally representative sample (61% response rate). This study examines 201,496 beneficiaries of age 65 and older with PD coverage [6% Hispanic, 7% non-Hispanic Black, 3% non-Hispanic Asian or Pacific Islander (API)]. Key variables are self-reported race/ethnicity and Consumer Assessment of Health Care Providers and Systems getting information and needed PDs measures. DATA COLLECTION/EXTRACTION METHODS: We generated weighted case-mix adjusted means for 4 racial/ethnic groups and for Hispanics separately by English-language or Spanish-language preference status. We calculated within-plan disparities using a linear mixed-effect model, with fixed effects for race/ethnicity, coverage type and case-mix variables, and random effects for contract and contract by race/ethnicity interactions. PRINCIPAL FINDINGS: Disparities for Hispanic, Black, and API beneficiaries on obtaining needed PDs and information regarding coverage range from −2 to −11 points (0–100 scale) relative to non-Hispanic Whites, with the greatest disparities observed for Spanish-preferring Hispanics and API beneficiaries, especially those with low income. There is wide variation in disparities across contracts, and contracts with the largest disparities for Hispanics have higher proportions of beneficiaries with lower education and income. CONCLUSIONS: Quality improvement efforts may be needed to reduce racial/ethnic disparities in beneficiary experience with PD coverage. Cultural, language, and health literacy barriers in navigating Medicare's Part D program may partially explain the observed disparities.

Key Findings

  • Compared with non-Hispanic White beneficiaries, Hispanic, Black, and Asian or Pacific Islander beneficiaries report more problems with getting needed prescription drugs and information.
  • Cultural, language, and health literacy barriers in navigating Medicare's Part D program may partially explain the observed disparities.

Recommendation

Quality improvement efforts may be needed to reduce racial/ethnic disparities in beneficiary experience with prescription drug coverage.

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