An evaluation of Medicare beneficiary assessments of healthcare: Do race/ethnicity and membership in managed care impact the perceived quality of healthcare for Hispanic seniors?

摘要

Hispanic seniors are one of the largest growing U.S. demographics. Yet, due to the relative lack of viable data on this population, research assessing their satisfaction with Medicare-covered healthcare services is sparse. Additionally, because Hispanic seniors are enrolling in an expanding Medicare managed care (MMC) program at greater rates than other racial/ethnic senior groups, policymakers are concerned if Hispanic seniors receive the same quality of care in MMC, compared to the traditional fee-for-service (MFFS) plan, as well as seniors of different racial/ethnic background. This dissertation provides a timely and relevant examination of the perception of healthcare quality, as reported by non-institutionalized Hispanic seniors in the two different modes of Medicare benefit delivery, as well as a comparison to African American and white seniors. By analyzing information within a combined MFFS/MMC 2004 CAHPS dataset, two questions were evaluated: (1) the role of Hispanic ethnicity in predicting patient satisfaction measures, and; (2) the role of membership in two different types of Medicare plans in predicting satisfaction measures for Hispanic seniors. A variation of the Behavioral Model of Healthcare Services Use was employed in the conceptual framework. From the analyses, for most measures, Hispanic seniors were more satisfied in the MFFS plan than in MMC plans. Furthermore, Hispanic seniors, in both plan types, were more satisfied than African American and white seniors with their: overall care; primary care provider; physician specialists; overall Medicare plan and; customer service. Hispanic seniors were less favorable, compared to African American and white seniors, of receiving needed, timely and respectful care. Findings for Hispanic seniors were mixed on communication, with those in MMC plans being less satisfied than other racial/ethnic groups, and MFFS Hispanic seniors being more satisfied. Finally, a supplemental analysis of a MMC plan with high-Hispanic enrollee concentration, as well as the MFFS seniors within its service area, was used to compare to the entire CAHPS population. This MMC plan, with a delivery system that caters to Hispanic needs, produced greater satisfaction in key areas for Hispanic seniors, compared to the MFFS seniors in the plan's area, as well as Hispanic MMC seniors nationwide.