Health care disparities in disadvantaged Medicare beneficiaries: a national project review

The wealth of literature documenting differences in health care utilization by race and ethnicity underscores the need to develop a system to effectively measure health care related disparities. The Centers for Medicare & Medicaid Services has taken the first steps toward detailing the quality of care for fee-for-service (FFS) Medicare beneficiaries. Using data collected for the two-period 1997-1999 on a cross-section of beneficiaries from all states and territories of the U.S., quality was measured using a set of 24 indicators of care. The results of this effort were reported in the October 4, 2000 issue of the Journal of the American Medical Association. This article reports similar measures of quality but focuses specifically on disparities in the indicators among five disadvantaged Medicare beneficiary groups: African-American, American Indian/Alaska Natives, Asian/Pacific Islanders, Hispanics, and Medicare beneficiaries enrolled in Medicaid (dually enrolled). These indicators serve as a baseline for tracking quality improvement within disadvantaged populations and evaluating the success of efforts to reduce health care disparities at the national level. The findings suggest that patterns of disparities exist in both the inpatient and outpatient settings for disadvantaged beneficiaries. Over the next decade, the composition of Medicare beneficiaries will become more diverse. This increasing diversity makes it imperative to identify and monitor the existence and extent of health care disparities. The consistent and ongoing evaluation of racial, ethnic, and socioeconomic disparities should provide an incentive to create effective preventive programs tailored to specific community needs.