Medicare + Choice and Minority Elderly

描述（由申请人提供）：医疗保险专门负责为老年人和/或残疾美国居民以及终末期肾病患者提供医疗保健服务。虽然医疗保险已经成功地大大改善了获得医疗服务的机会和其选民的整体健康，但研究表明，医疗保险受益人的种族/族裔与医疗不平等有关。从表面上看，医疗保险健康维护组织（HMO）似乎解决了与这些不平等相关的一些因素，然而，医疗保险HMO计划，现在称为医疗保险+选择（M+C），由于平衡预算法案（BBA）和随后的修订，本身正在经历重大的计划变化，例如，平衡预算修正法（BBRA）和福利改善和保护法（BIPA）。这项研究有两大目标。首先，我们将确定与老年白色、黑人和西班牙裔Medicare受益人的M+C计划登记相关的个人水平特征，老年黑人和西班牙裔受益人报告的影响其在HMO登记的因素是否与影响老年白色Medicare受益人的因素不同，以及在HMO登记的老年黑人和西班牙裔受益人是否与HMO登记的老年白色受益人在自我报告的健康状况，医疗保健的使用，和感知到的获得护理的机会。其次，我们将研究不同种族/民族分类受益人的Medicare HMO和福利套餐的可用性，HMO入学率如何与种族/民族分类和计划福利范围相关，以及不同种族/民族群体的HMO和HMO入学的可用性如何在实施BBA条款后发生变化。我们将使用调查和基于人口的方法（使用医疗保险管理数据和其他基于人口的数据）来检查影响获得和使用医疗保健的个人和系统层面的因素，计划和服务的可用性，以及投保人的计划选择。这项研究将提供第一次全面检查的个人和系统层面的因素影响少数使用的医疗保险HMO，并将提供所需的信息，如何不断发展的医疗保险系统正在影响医疗保健的黑人和西班牙裔医疗保险受益人。

DESCRIPTION (provided by applicant): Medicare is specifically mandated to provide health care services to elderly and/or disabled United States residents, as well as those with end stage renal disease. Although Medicare has been successful in dramatically improving both the access to care and the overall health of its constituents, studies have shown inequalities in care associated with the race/ethnicity of Medicare beneficiaries. On the surface, Medicare health maintenance organizations (HMOs) appear to address some of the factors associated with these inequalities, however, the Medicare HMO program, now called Medicare+Choice (M+C), is itself undergoing substantial program changes as a result of the Balanced Budget Act (BBA) and subsequent revisions, e.g., the Balanced Budget Revision Act (BBRA) and the Benefits Improvement and Protection Act (BIPA). This study has two broad objectives. First, we will determine individual level characteristics related to M+C plan enrollment among elderly White, Black, and Hispanic Medicare beneficiaries, whether the factors which elderly Black and Hispanic beneficiaries report as influencing their enrollment in HMOs differ from those that influence elderly White Medicare beneficiaries, and whether elderly Black and Hispanic beneficiaries enrolled in HMOs differ from HMO enrolled elderly White beneficiaries in terms of their self-reported health, use of health care, and perceived access to care. Second, we will examine the availability of Medicare HMOs and benefit packages for beneficiaries of differing race/ethnic classifications, how HMO enrollment rates are related to race/ethnic classification and range of plan benefits, and how the availability of HMOs and HMO enrollment by different race/ethnic groups changed subsequent to implementation of BBA provisions. We will use both survey and population-based (using Medicare administrative data and other population-based data) methodologies to examine individual and system level factors affecting access to and use of medical care, the availability of plans and services, and plan selection by enrollees. This study will provide the first comprehensive examination of both individual and system level factors affecting minority use of the Medicare HMOs, and will provide needed information on how the evolving Medicare system is affecting health care for Black and Hispanic Medicare beneficiaries.