RACIAL DISPARITIES AND MEDICARE PREVENTIVE SERVICES

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The proposed research responds to the NIA Pilot Research Grant Program objective to "Reduce Health Disparities Among Older Persons and Populations" by examining topic number 20, "Racial/Ethnic Differences and Health Disparities." Although disparities in health care use and outcomes across racial and ethnic groups are well documented, the reasons for such disparities are poorly understood. It has been shown that minorities use fewer preventive services, and suffer higher rates of illnesses targeted by such preventions than other groups. The proposed research will use Medicare's expansion of preventive services coverage during the 1990's as a "natural experiment" to test whether insurance coverage of preventive services reduces racial and ethnic disparities in health care and health outcomes in an elderly population. The specific aims are: 1) to examine how expansions in the coverage of Medicare preventive services during the 1990s (influenza shots, mammography, and colorectal cancer screens) affected racial disparities in the receipt of these services; and 2) to examine whether changes in Medicare coverage of influenza shots, mammography, and colorectal cancer screens led to measurable changes in health outcomes related to these services. Using two publicly available data sources and a unique panel of seriously ill Medicare beneficiaries and spouses followed during the 1990s, the proposed research will use a difference-in-differences strategy to compare differential service use and differential health outcomes across racial and ethnic groups before and after Medicare coverage expansions.