Medicare + Choice and Minority Elderly

描述（由申请人提供）：医疗保险是专门为老年和/或残疾美国居民以及终末期肾脏疾病患者提供医疗保健服务的。尽管医疗保险成功地大大改善了获得医疗服务的机会和其组成部分的整体健康状况，但研究表明，医疗保险受益人的种族/族裔与护理方面的不平等有关。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，医疗保险健康维护组织计划，现在被称为医疗保险+选择（M+C），由于《平衡预算法案》（BBA）和随后的修订，例如《平衡预算修订法案》（BBRA）和《福利改善和保护法案》（BIPA），它本身正在经历重大的计划变化。这项研究有两大目标。首先，我们将确定老年白人、黑人和西班牙裔医疗保险受益人中与M+C计划登记相关的个人水平特征，以及黑人和西班牙裔老年医疗保险受益人报告的影响其参加hmo的因素是否与影响老年白人医疗保险受益人的因素不同。以及参加HMO的老年黑人和西班牙裔受益人是否与参加HMO的老年白人受益人在自我报告的健康状况、医疗保健的使用和获得医疗保健的感知方面有所不同。其次，我们将检查不同种族/民族分类受益人的医疗保险HMO和福利计划的可获得性，HMO注册率与种族/民族分类和计划福利范围的关系，以及不同种族/民族群体的HMO可获得性和HMO注册在BBA规定实施后的变化情况。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）来检查个人和系统层面的因素，这些因素影响医疗保健的获取和使用，计划和服务的可用性，以及投保人的计划选择。这项研究将首次全面考察影响少数族裔使用医疗保险hmo的个人和系统层面因素，并将提供有关不断发展的医疗保险系统如何影响黑人和西班牙裔医疗保险受益人的医疗保健的必要信息。

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.