Although analysis results did not exhibit consistent patterns, several findings are worth noting. The most consistent finding was related to access to care. Women more often reported experiencing one or more delays in care compared to men, and delays were significantly more common among the 45–64 age groups than in the ≥65 age group. These findings are consistent with previous research that found improved access to care among older adults since the implementation of Medicare (NASI 2006). Non-Hispanic Whites were more likely than non-Hispanic Blacks or Hispanics to report delays. It is possible that people of different race/ethnicity groups have different perceptions, shaped by historical patterns, of necessary care or getting care as soon as they want it. Non-Hispanic Whites have had greater access to services and higher utilization compared to others. Gender differences in age and race/ethnicity strata may relate to women's lower economic status,
Among effectiveness of care measures, racial/ethnic disparities favoring non-Hispanic Whites over non-Hispanic Blacks and Hispanics were common, particularly among persons with diabetes. These results are consistent with the existing literature on disparities. While racial/ethnic disparities were found in both age groups, they tended to be stronger in magnitude and more often statistically significant for midlife adults 45–64 compared to older adults ≥65. Because most effectiveness of care measures available in this dataset examined processes of care, improved coverage through Medicare may help to diminish disparities for the older age group. Other measures of quality that examine control of blood pressure and cholesterol, where larger disparities have been observed in the Medicare population, were not assessed because the measures were not available in the MEPS data set (Chou et al 2007a; Trivedi et al 2006).
There are limitations to this analysis. First is the reliance on self-reported disease status to identify older adults with diabetes and cardiovascular conditions. There is the possibility of misclassification because some individuals who self-identify as having these conditions may not actually have them. In particular, people with diabetes may not meet the clinical definition of the disease. However, there is evidence that older adults can reliably report their chronic conditions, and the positive predictive value of such reports is high (Miller et all 2008; Silliman and Lash 1999).
Second, because of data limitations, comparison across all race, gender and age-group strata were not always reliable, which may explain the failure of some results to reach statistical significance. This study does not adjust for other factors that may influence quality of care, other than Medicare eligibility status among older adults on either side of the Medicare threshold, although results are stratified and reported by race/ethnicity and gender groups. Other factors include patient values and preferences for care; presence of comorbid conditions; functioning and health status; geographic region; education and income; and presence of other insurance (besides Medicare). However, prior research on disparities have found that since its implementation, Medicare has improved access to care for older adults, confirming at least one aspect of the findings and bolstering others. Despite the limitations, analysis provides nationally representative data on the quality of care that allows the comparison of care for pre-Medicare and Medicare age patients, and explores whether disparities based on race/ethnicity and gender are common in the two age groups.