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

项目摘要/摘要 联邦医疗保险优势(MA)计划在过去十年中经历了实质性的增长，特别是 在种族/民族少数群体中。MA通过以下方式提供传统Medicare(TM)保险的替代方案 医疗保险受益人将从私营保险公司获得综合医疗和处方药保险。 尽管MA服务于越来越多的黑人和西班牙裔受益人，但目前尚不清楚MA是否 缓解或加剧护理方面的种族/民族差异，以及某些MA计划是否提供更高的 与其他MA计划相比，对黑人和西班牙裔参保者的质量和更公平的照顾。确凿的证据是 需要在医疗保险计划和设计中确定减少医疗保健差距的机会 对MA计划的激励措施，以改善对黑人和西班牙裔注册人员的护理。因此，总的目标是 这项研究旨在调查MA的入学是否缓解或加剧了种族/民族差异(即， 黑人与白人、西班牙裔与白人受益人之间)在获得、质量和利用相对护理方面 到TM；确定高质量和高权益的MA计划；开发和验证患者的测量 信任、歧视和公平照顾方面的经验，可纳入未来对 马云策划演出。我们利用了丰富的国家数据来源，包括目前的联邦医疗保险受益人 调查和遇到Medicare Advantage计划提交的索赔，并将进行全国调查 医疗保险受益人评估在护理方面的信任、歧视和公平体验以评估 在护理的不同方面(获取机会、质量和患者体验)存在差异。我们将超越 通过明确调查受益人在以下方面的经验，对医疗保险人群进行现有调查 公平、信任和护理方面的歧视，并将提供证据指导这些项目如何可能 纳入未来的患者体验调查和MA计划绩效评估(例如，计划 星级)。因此，本项目将说明MA计划的总体主要特征，以及 具体的MA计划，影响到对种族/少数民族的关怀。它还将提供新的证据，以告知 政策制定者在评估MA计划的质量时可以考虑公平性，包括评估 患者在公平与不公平护理方面的体验。这项工作涉及NIA 2020年的战略优先事项- 25找出造成差距的卫生系统因素和减少保健的政策机会 老年人之间的差距。为了加强我们工作的影响力，我们将通过 科学出版物和政策利益攸关方国家网络，包括政策咨询委员会 由医疗保险政策、MA计划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.