As a tool for containing health insurance costs, managed care has grown dramatically for a number of years, first among private employers, then in Medicaid programs and in the Medicare system. Today, 40% of older persons in California (40%) are in Medicare HMOs; nationwide, about 17% of the elderly population is in a Medicare HMO. Using the 1996 Medicare Current Beneficiary Survey that included an oversample of HMO members we find that Medicare HMOs fail to eliminate the gap between minority elderly (specifically Latino and African American) persons and non-Latino white elderly persons across three distinct dimensions of access to health care: availability, accessibility and acceptability. And in the case of older Latinos outside of California, Medicare HMOs may even exacerbate the inequalities. Although ethnic/racial gaps in health care access remain in Medicare HMOs, managed care does, in certain significant aspects, improve access to health services among the minority elderly. Most strikingly, in comparison to the traditional Medicare fee-for-service system, HMOs clearly offer better access to care for California’s elderly Latinos. Outside the state, Medicare HMOs have the greatest positive impact on non-Latino whites (hereafter referred to as “whites”). The findings of continued disparities in access to care for racial/ethnic minorities, both in California and the rest of the United States, indicate that further efforts are needed to improve access for Latino and African American elders in managed care before considering mandatory HMO enrollment of Medicare beneficiaries.
Learning Objectives: 1. Describe the access to care indicators where minority elderly in Medicare fee for service (FFS) differ from nonLatino white elderly 2. Identify access indicators where Medicare HMO members differ from FFS members by race/ethnicity 3. Analyze how differences in access between Medicare FFS and HMOs lead to the narrowing or widening of access gaps between races/ethnicities.
Keywords: Managed Care, Health Care Access
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