Racial/Ethnic Disparities in Medicare Advantage vs. Traditional Medicare: Evidence to Improve Equity in Medicare

项目总结/摘要 医疗保险优势（MA）计划在过去十年中经历了大幅增长，特别是 种族/少数民族。MA提供了一个替代传统的医疗保险（TM）覆盖范围， 医疗保险受益人从私人保险公司获得综合医疗和处方药保险。 虽然MA为越来越多的黑人和西班牙裔受益人提供服务，但目前尚不清楚MA是否 减轻或加剧了种族/民族的差异，以及某些MA计划是否提供更高的 质量和更公平的照顾黑人和西班牙裔注册者比其他MA计划。有力的证据表明 需要确定机会，以减少医疗保险计划和设计中的医疗保健差距 MA计划的激励措施，以改善对黑人和西班牙裔注册者的护理。因此， 本研究旨在调查MA的入学是否减轻或加剧了种族/民族差异（即， 黑人与白色和西班牙裔与白色受益人之间）在获得、质量和利用护理亲属方面的差异 以TM;确定高质量和高公平的MA计划;并制定和验证患者的措施 信任、歧视和公平照顾方面的经验，可纳入未来的评估， MA计划绩效。我们利用丰富的国家数据来源，包括Medicare Current Benefits 调查和遇到医疗保险优势计划提交的索赔，还将进行全国调查 的医疗保险受益人，以评估经验与信任，歧视和公平的照顾，以评估 在不同的护理维度（可及性、质量和患者体验）上存在沿着的差异。我们将超越 现有的医疗保险人口调查，明确调查受益人对他们的经验， 公平，信任和歧视的照顾，并将提供证据，以指导如何这些项目可以 纳入未来的患者体验调查和MA计划绩效评估（例如，计划 星星收视率）。因此，本项目将阐明如何MA计划的整体关键特征， 特别是MA计划，影响到对种族/少数民族的照顾。它还将提供新的证据， 政策制定者在评估千年评估计划的质量时， 患者体验公平与不公平的护理。这项工作涉及NIA 2020年的战略优先事项- 25确定造成差异的卫生系统因素和减少卫生保健的政策机会 老年人之间的差距。为了加强我们工作的影响力，我们会透过 科学出版物，以及包括政策咨询委员会在内的国家政策利益攸关方网络 由医疗保险政策、硕士项目和差异方面的专家组成。

PROJECT SUMMARY / ABSTRACT The Medicare Advantage (MA) program has experienced substantial growth over the last decade, particularly among racial/ethnic minorities. MA offers an alternative to traditional Medicare (TM) coverage by allowing Medicare beneficiaries to receive integrated medical and prescription drug coverage from private insurers. Although MA serves a growing population of Black and Hispanic beneficiaries, it remains unclear whether MA mitigates or exacerbates racial/ethnic disparities in care, as well as whether certain MA plans provide higher quality and more equitable care for Black and Hispanic enrollees than other MA plans. Rigorous evidence is needed to identify opportunities to reduce health care disparities in the Medicare program and design incentives for MA plans to improve care for Black and Hispanic enrollees. Thus, the overarching objectives of this study are to investigate whether enrollment in MA mitigates or exacerbates racial/ethnic disparities (i.e., between Black vs. white and Hispanic vs. white beneficiaries) in access, quality, and utilization of care relative to TM; to identify high-quality and high-equity MA plans; and to develop and validate measures of patient experiences with trust, discrimination, and equitable care that could be incorporated into future assessments of MA plan performance. We draw on rich sources of national data, including the Medicare Current Beneficiary Survey and encounter claims submitted by Medicare Advantage plans, and will also conduct a national survey of Medicare beneficiaries to assess experiences with trust, discrimination, and equity in care to evaluate disparities along different dimensions of care (access, quality, and patient experiences). We will go beyond existing surveys of the Medicare population by explicitly surveying beneficiaries about their experiences with equity, trust, and discrimination in care, and will provide evidence to guide how these items could be incorporated into future surveys of patient experiences and assessments of MA plan performance (e.g., plan star ratings). Thus, this project will illuminate how key features of the MA program overall, and attributes of particular MA plans, affect care for racial/ethnic minorities. It will also provide new evidence to inform how policymakers could take equity into account when evaluating the quality of MA plans, including assessing patient experiences with equitable vs. inequitable care. This work addresses NIA’s strategic priorities for 2020- 25 to identify health system factors underlying disparities and policy opportunities to reduce health care disparities among older adults. To enhance the impact of our work, we will disseminate findings through scientific publications and to a national network of policy stakeholders, including a Policy Advisory Committee comprised of experts in Medicare policy, the MA program, and disparities.