RESUMO
BACKGROUND: Each year, about 10% of Medicare Advantage (MA) enrollees voluntarily switch to another MA contract, while another 2% voluntarily switch from MA to fee-for-service Medicare. Voluntary disenrollment from MA plans is related to beneficiaries' negative experiences with their plan, disrupts the continuity of care, and conflicts with goals to reduce Medicare costs. Little is known about racial/ethnic disparities in voluntary disenrollment from MA plans. OBJECTIVE: The objective of this study was to investigate differences in rates of voluntary disenrollment from MA plans by race/ethnicity. SUBJECTS: A total of 116,770,319 beneficiaries enrolled in 736 MA plans in 2015. METHODS: Differences in rates of disenrollment across racial/ethnic groups [Asian or Pacific Islander (API), Black, Hispanic, and White] were summarized using 4 types of logistic regression models: adjusted and unadjusted models estimating overall differences and adjusted and unadjusted models estimating within-plan differences. Unadjusted overall models included only racial/ethnic group probabilities as predictors. Adjusted overall models added age, sex, dual eligibility, disability, and state of residence as control variables. Between-plan differences were estimated by subtracting within-plan differences from overall differences. RESULTS: Adjusted rates of disenrollment were significantly (P<0.001) higher for Hispanic (+1.2 percentage points), Black (+1.2 percentage points), and API beneficiaries (+2.4 percentage points) than for Whites. Within states, all 3 racial/ethnic minority groups tended to be concentrated in higher disenrollment plans. Within plans, API beneficiaries voluntarily disenrolled considerably more often than otherwise similar White beneficiaries. CONCLUSION: These findings suggest the need to address cost, information, and other factors that may create barriers to racial/ethnic minority beneficiaries' enrollment in plans with lower overall disenrollment rates.
Assuntos
Etnicidade/estatística & dados numéricos , Medicare Part C/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Medicare , Pessoa de Meia-Idade , Estados UnidosRESUMO
BACKGROUND: Disparities in clinical process-of-care and patient experiences are well documented for Medicare beneficiaries with ≥1 social risk factors. If such patients are less willing to express disagreement with their doctors or change doctors when dissatisfied, these behaviors may play a role in observed disparities. OBJECTIVE: To investigate the association between social risk factors and self-reported likelihood of disagreeing with or changing doctors if dissatisfied among the Medicare fee-for-service population. SUBJECTS: Fee-for-service beneficiaries (N=96,317) who responded to the 2014 Medicare Consumer Assessment of Healthcare Providers and Systems survey. Subgroups were defined based on age, education, income, and race/ethnicity. METHODS: Respondents reported how likely they would be to express disagreement with their doctors and change doctors if dissatisfied (1=very unlikely to 4=very likely; rescaled to 0-100 points). We fit mixed-effect linear regression models predicting these outcomes from social risk factors, controlling for health status and geographic location. RESULTS: Beneficiaries who were older, less educated, and had lower incomes were least inclined to express disagreement or change doctors (P<0.001). Compared with non-Hispanic whites, Asian/Pacific Islander (-9.5) and Hispanic (-3.6) beneficiaries said they would be less likely, and black (+2.8) beneficiaries more likely, to express disagreement. Asian/Pacific Islander (-8.7), Hispanic (-5.9), and American Indian/Alaska Native (-3.8) beneficiaries were less inclined than non-Hispanic whites to change doctors (P<0.01). DISCUSSION: Reduction in health care disparities may be achieved if doctors and advocates encourage vulnerable patients to express their concerns and perspectives and if communities and caregivers provide support for changing providers when care is poor.