Medicare + Choice a nd Minority Elderly

描述(由申请人提供)：联邦医疗保险特别授权为老年和/或残疾美国居民以及患有终末期肾脏疾病的人提供医疗保健服务。尽管医疗保险在极大地改善其成员获得医疗保健的机会和整体健康方面取得了成功，但研究表明，医疗保健方面的不平等与医疗保险受益人的种族/族裔有关。从表面上看，联邦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，由于平衡预算法(BBA)和随后的修订，例如平衡预算修订法(BBRA)和福利改善和保护法(BIPA)，联邦医疗保险HMO计划，现在称为联邦医疗保险选择(MC)，本身正在经历重大的计划变化。这项研究有两个广泛的目标。首先，我们将确定与老年白人、黑人和西班牙裔联邦医疗保险受益人参加医保计划相关的个人水平特征，黑人和西班牙裔老年受益人报告的影响他们参加医疗保健计划的因素是否与影响老年白人联邦医疗保险受益人的因素不同，以及参加医疗保健组织的黑人和西班牙裔老年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是否与医疗保健组织登记的老年白人受益人不同。其次，我们将研究为不同种族/民族分类的受益人提供的医疗保险HMO和福利方案，HMO的投保率如何与种族/民族分类和计划福利的范围相关，以及不同种族/民族的HMO和HMO的投保情况在BBA条款实施后发生了怎样的变化。我们将使用调查和基于人口的方法(使用联邦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、计划和服务的可用性以及参保人选择计划的个人和系统层面的因素。这项研究将首次对影响少数人使用联邦医疗保险HMO的个人和系统层面因素进行全面检查，并将提供有关不断发展的联邦医疗保险制度如何影响黑人和西班牙裔联邦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.