HMO enrollment by Medicare beneficiaries in heterogeneous communities

This study examines the effect of ethnicity, race, and other socioeconomic and utilization variables on belonging to a fee-for-service or capitated plan by Medicare beneficiaries. Native-born beneficiaries cite health status, physical access to health care facilities, and income levels as affecting their choice. Immigrants, on the other hand, mention age, a lifestyle of living alone, and income as influencing their decision. Among foreign-born nationals, race appears to play an important role in choosing health care plans. A key factor affecting enrollment among immigrant populations appears to be the availability of ethnic sensitive providers of health care. While the elderly Hispanic immigrant population utilizes participating providers in prepaid plans catering to a Spanish-speaking population, the lack of similar facilities among predominantly black immigrant neighborhoods inhibits participation in HMOs by elderly immigrants from places such as Haiti and the Caribbean Basin. Policy implications are discussed.