Health Care Management Science

, Volume 15, Issue 1, pp 15–28 | Cite as

Medicare managed care and primary care quality: examining racial/ethnic effects across states

Article

Abstract

The study assesses the role of Medicare Advantage (MA) plans in providing quality primary care in comparison to FFS Medicare in three states, New York, California, Florida, across three racial ethnic groups. The performance is measured in terms of providing better quality primary care, as defined by lowering the risks of preventable hospital admissions. Using 2004 hospital discharge data (HCUP-SID) of Agency for Healthcare Research and Quality for three states, a multivariate cross sectional design is used with individual admission as the unit of analysis. The study found that MA plans were associated with lower preventable hospitalizations relative to marker admissions. The benefit also spilled over to different racial and ethnic subgroups and in some states, e.g. CA and FL, MA enrollment was associated with significantly lower odds of minority admissions than of white admissions. These results may indicate a potentially favorable role of MA plans in attenuating racial/ethnic inequalities in primary care in some states.

Keywords

Managed care Medicare Racial and ethnic disparities Preventable hospitalizations Ambulatory care senstive conditions Primary care 

References

  1. 1.
    Gaskin DJ, Hoffman C (2000) Racial and ethnic differences in preventable hospitalizations across 10 states. Med Care Res Rev 57(Supplement 1):85–107Google Scholar
  2. 2.
    Atherly A, Thorpe K (2005) Value of medicare advantage to low income and minority medicare beneficiaries. Report prepared for Blue Cross Blue Shield Association, SeptemberGoogle Scholar
  3. 3.
    Schneider EC, Zaslavsky MA, Epstein M (2002) Racial disparities in the quality of care for enrollees in medicare managed care. JAMA 287:1288–1294CrossRefGoogle Scholar
  4. 4.
    Trivedi AN, Zaslavsky AM, Schneider EC et al (2005) Trends in the quality of care and racial disparities in Medicare managed care. NJEM 353(7):692–700CrossRefGoogle Scholar
  5. 5.
    Trivedi AN, Zaslavsky AM, Schneider EC et al (2006) Relationship between quality of care and racial disparities in Medicare health plans. JAMA 296:1998–2004CrossRefGoogle Scholar
  6. 6.
  7. 7.
    AHRQ (2000) HCUP fact book no. 5. Preventable hospitalizations: window into primary and preventive care, 2000Google Scholar
  8. 8.
    Blustein J, Hanson K, Shea S (1998) Preventable hospitalizations and socioeconomic status. Health Aff 17(2):177–189CrossRefGoogle Scholar
  9. 9.
    National Health Policy Forum | www.nhpf.org, November 29, 2005
  10. 10.
    Pope GL, Greenwald M, Kautter J et al (2006) Medicare preferred provider organization demonstration: plan offerings and beneficiary enrollment. Health Care Financ Rev 27(3):96–109Google Scholar
  11. 11.
    Basu J, Mobley L (2007) Do HMOs reduce preventable hospitalizations for Medicare beneficiaries? Med Care Res Rev 64(5):544–567CrossRefGoogle Scholar
  12. 12.
    Billings J, Zeitel L, Lukomnik J et al (1993) Impact of socioeconomic status on hospital use in New York City. Health Aff (Millwood) 12(1):162–173CrossRefGoogle Scholar
  13. 13.
    Bindman AB, Grumback K, Osmond D, Komaromy M, Vranizan K, Lurie N, Billings J, Stewart A (1995) Preventable hospitalizations and access to health care. J Am Med Assoc 274(4):305–311CrossRefGoogle Scholar
  14. 14.
    Schoenman JA, Parente ST, Feldman JJ, Shah MM, Evans WN, Finch MD (2005) Impact of HMO withdrawals on vulnerable Medicare beneficiaries. Health Care Financ Rev 26(3):5–30Google Scholar
  15. 15.
    Gold M, Achman L, Mittler J, et al (2004) Monitoring Medicare_Choice: what have we learned? Findings and operational lessons for Medicare Advantage. MPR publication no. 8846–200, contract no. 43005 for Robert Wood Johnson Foundation. Princeton, NJ: Mathematica Policy Research, IncGoogle Scholar
  16. 16.
    Basu J, Friedman B, Burstin H (2002) Primary care, HMO enrollment, and hospitalization for ambulatory care sensitive conditions: a new approach. Med Care 40(12):1260–1269CrossRefGoogle Scholar
  17. 17.
    Basu J, Friedman B, Burstin H (2004) Managed care and preventable hospitalization among Medicaid adults. Health Serv Res 39(3):489–510CrossRefGoogle Scholar
  18. 18.
    Goodman DC, Mick SS, Bott D et al (2003) Primary care service areas: a new tool for the evaluation of primary care services. Health Serv Res 38(1):287–310CrossRefGoogle Scholar
  19. 19.
    Mobley LR, Root ED, Anselin L et al (2006) Spatial analysis of elderly access to primary care services. International Journal of Health Geographics, 5, epub May 15, http://www.ij-healthgeographics.com/content/5/1/19
  20. 20.
    Anderson RM (1995) Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 36:1–10CrossRefGoogle Scholar
  21. 21.
    Coffey RM, Goldfarb MG (1986) DRGs and disease staging for reimbursing Medicare patients. Med Care 24(9):814–829CrossRefGoogle Scholar
  22. 22.
    Basu J, Friedman B (2007) A reexamination of distance as a proxy for severity of illness and implications for differences in utilization by race/ethnicity. Health Econ 16:687–701CrossRefGoogle Scholar
  23. 23.
    Basu J, Mobley L (2010) Impact of local resources on hospitalization patterns of medicare beneficiaries and propensity to travel outside local markets. J Rural Health 26(1):30–35, WinterCrossRefGoogle Scholar
  24. 24.
    Ansari Z, Laditka JN, Laditka SB (2006) Access to health care and hospitalization for ambulatory care sensitive conditions. Med Care Res Rev 63(6):719–741CrossRefGoogle Scholar
  25. 25.
    Schreiber S, Zielinsky T (1997) The meaning of ambulatory care sensitive admissions: urban and rural perspectives. J Rural Health 13(4):276–284CrossRefGoogle Scholar
  26. 26.
    AHRQ (2004) Agency for healthcare research and quality: Healthcare Cost and Utilization Project (HCUP). Rockville, MD. Accessed online December 2005: http://www.hcup-us.ahrq.gov/db/state/siddbdocumentation.jsp
  27. 27.
    Call KT, Dowd B, Feldman R et al (1999) Selection experiences in Medicare HMOs: pre-enrollment expenditures. Health Care Financ Rev 20(4):197–209Google Scholar
  28. 28.
    Mello MM, Stearns SC, Norton EC et al (2003) Understanding biased selection in medicare HMOs. Health Serv Res 38(3):961–992CrossRefGoogle Scholar
  29. 29.
    Basu J, Friedman B, Burstin H (2006) Preventable hospitalization and Medicaid managed care: does race matter? J Health Care Poor Underserved 17(1):101–115CrossRefGoogle Scholar
  30. 30.
    Greenberg G, Brandon WP, Schoeps N et al (2003) Medicaid managed care and racial differences in satisfaction and access. J Health Care Poor Underserved 14(3):351–371Google Scholar

Copyright information

© Springer Science+Business Media, LLC (outside the USA) 2011

Authors and Affiliations

  1. 1.Center for Primary care, Prevention, and Clinical Partnerships Agency for Healthcare Research and QualityRockvilleUSA

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