Although disparities in the use of health services by race and income have diminished since Medicare's implementation, recent studies suggest that marked health care disparities persist among Medicare beneficiaries. Racial/ethnic minority beneficiaries fare worse than their White counter-parts on numerous measures of health status and care. For example, Blacks have a shorter life expectancy at age 65 than Whites. In addition, Black beneficiaries are more likely than Whites to have chronic conditions and to experience poorer quality of care based on HEDIS measures (Chou et al
Since health insurance characteristics of the population change sharply at age 65, when most people become eligible for Medicare, one important question is whether these changes matter in terms of disparities in health care quality. Improvement in the quality of care upon Medicare eligibility may produce substantial health benefits and improved outcomes, such as long-term reductions in health care expenditures and healthier populations with less intensive health care needs. However, it is less clear whether midlife adults who have not yet reached Medicare eligibility (45–64) experience the same extent of disparities as older adults who have reached Medicare eligibility. Significant differences in health care quality experiences between these two age groups suggest that change in Medicare eligibility matters. This is particularly important as large numbers of baby boomers
This chapter examines the differences in quality of care among older adults using data from the Medical Expenditure Panel Survey (MEPS), a nationally representative database of well-established indicators of health care status, access to care, insurance coverage and, most important, quality of care.2 Because MEPS is intended for government quality initiatives and reports on quality indicators for priority conditions across a wide range of ages and race/ethnicities, it offers a unique opportunity to assess the extent of equitable care for older adults on either side of the Medicare eligibility threshold.
This analysis presents new evidence on whether attainment of Medicare eligibility among older adults is associated with quality of care, particularly for those with diabetes or cardiovascular disease. The analysis assesses relative disparities in quality of care for those on either side of the Medicare threshold: pre-Medicare midlife adults (45–64) compared to older Medicare beneficiaries (≥65). Specifically, select indicators of diabetes and cardiovascular quality of care for midlife adults who have not yet reached Medicare eligibility are compared to older Medicare beneficiaries overall and stratified by race/ethnicity groups and sex. The analysis examines diabetes and cardiovascular disease because these conditions are highly prevalent and costly, requiring continuous maintenance treatment. In addition, there are numerous quality of care measures from the MEPS database related to diabetes and cardiovascular care across multiple dimensions of quality,
2 Detailed information on MEPS is available online at http://www.meps.ahrq.gov/mepsweb.