POTENTIAL EFFECTS OF RACIAL AND ETHNIC DISPARITIES IN MEETING MEDICARE
Author(s)
Wang J1, Qiao Y1, Shih YT2, Spivey CA1, Wan JY3, White-Means SI3, dagogo-Jack S3, Cushman WC3, Chisholm-Burns M3
1The University of Tennessee College of Pharmacy, Memphis, TN, USA, 2University of Chicago, Chicago, IL, USA, 3The University of Tennessee Health Science Center, Memphis, TN, USA
OBJECTIVES: To examine racial and ethnic disparities in health status, health services utilizations and costs, and medication utilization based on Medicare medication therapy management (MTM) eligibility status. Greater disparities among MTM-ineligible than MTM-eligible individuals would suggest that MTM eligibility criteria have the potential to exacerbate racial and ethnic disparities in health outcomes. METHODS: This is a retrospective cross-sectional analysis of the Medicare Current Beneficiary Survey (2007-2008). A difference-in-differences model was used by including in regression models interaction terms between dummy variables for, e.g., non-Hispanic Blacks and MTM eligibility criteria, when examining racial disparities. Both main and sensitivity analyses were conducted to represent the ranges of the MTM eligibility thresholds used by insurance plans in 2010. The interaction term was interpreted on both the multiplicative term and the additive term. Various regression models were used. RESULTS: Whites were more likely to report self-perceived good health status than Blacks and Hispanics among both MTM-eligible and MTM-ineligible populations. Disparities were greater among MTM-ineligible than MTM-eligible populations (e.g., on additive term, difference in odds=1.94 and P<0.01 for Whites and Blacks; difference in odds=2.86 and P<0.01 for Whites and Hispanics in main analysis). When examining racial disparities, activities of daily living, instrumental activities of daily living, and generic possession ratio produced similar findings. Whites had a higher number of physician visits than Hispanics and the disparities were greater among the MTM-ineligible than MTM-eligible individuals (incidence rate ratio=1.40; P<0.01). Analyses on chronic conditions, costs of physician visits, hospitalizations, and total health care costs produced similar patterns on ethnic disparities. No other variables exhibited significant findings. CONCLUSIONS: Current MTM eligibility criteria may potentially aggravate existing racial and ethnic disparities in health services utilization and costs and medication utilization measures. Future research should examine strategies to remediate the effects of MTM eligibility criteria on racial and ethnic disparities.
Conference/Value in Health Info
2014-05, ISPOR 2014, Palais des Congres de Montreal
Value in Health, Vol. 17, No. 3 (May 2014)
Code
PHS166
Topic
Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Approval & Labeling, Public Health
Disease
Multiple Diseases