Racial/ethnic disparities in Medicare Part D experiences.
OBJECTIVE
To examine racial/ethnic differences in Medicare beneficiary experiences with Medicare Part D prescription drug (PD) coverage.


METHODS
2008 Consumer Assessment of Health Care Providers and Systems survey of U.S. Medicare beneficiaries.


METHODS
Surveys were administered by mail with phone follow-up to a nationally representative sample (61% response rate). This study examines 201,496 beneficiaries of age 65 and older with PD coverage [6% Hispanic, 7% non-Hispanic Black, 3% non-Hispanic Asian or Pacific Islander (API)]. Key variables are self-reported race/ethnicity and Consumer Assessment of Health Care Providers and Systems getting information and needed PDs measures.


METHODS
We generated weighted case-mix adjusted means for 4 racial/ethnic groups and for Hispanics separately by English-language or Spanish-language preference status. We calculated within-plan disparities using a linear mixed-effect model, with fixed effects for race/ethnicity, coverage type and case-mix variables, and random effects for contract and contract by race/ethnicity interactions.


RESULTS
Disparities for Hispanic, Black, and API beneficiaries on obtaining needed PDs and information regarding coverage range from -2 to -11 points (0-100 scale) relative to non-Hispanic Whites, with the greatest disparities observed for Spanish-preferring Hispanics and API beneficiaries, especially those with low income. There is wide variation in disparities across contracts, and contracts with the largest disparities for Hispanics have higher proportions of beneficiaries with lower education and income.


CONCLUSIONS
Quality improvement efforts may be needed to reduce racial/ethnic disparities in beneficiary experience with PD coverage. Cultural, language, and health literacy barriers in navigating Medicare's Part D program may partially explain the observed disparities.
H. John Heinz III College, Carnegie Mellon University, Pittsburgh, PA, USA.
Amelia M
AM
Haviland
Marc N
MN
Elliott
Robert
R
Weech-Maldonado
Katrin
K
Hambarsoomian
Nate
N
Orr
Ron D
RD
Hays
D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D003258:Consumer Behavior / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D054524:Medicare Part D / Q000592:standards / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data*; D014481:United States; D001741:Black or African American