Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 5.3 Implications and Recommendations


Efforts are needed to address persistent disparities in care based on race/ethnicity, socioeconomic status and gender, and for subgroups at particular risk.

As the nation considers options for expanding insurance coverage and improving the quality of care, this report has important implications for policymaking and for research. Special effort is needed to address persistent disparities in care based on race/ethnicity, socioeconomic status and gender, and for subgroups at particular risk. This study shows that even after controlling for health insurance, disparities persist in access to care. Because women report greater delays in care, comprehensive benefits and affordable costs are likely to be critical to the success of health care coverage options. Under current coverage models, women are at a disadvantage where benefits are limited or are associated with higher out-of-pocket costs (Patchias and Waxman, 2007). Furthermore, eliminating gender differences in access and quality of care issues may require efforts to strengthen the health care delivery system, increase gender-sensitive and appropriate delivery options and expand supportive mechanisms for women to gain access to health care. Similarly, efforts are needed to ensure that coverage options and benefits are adapted to improve effectiveness of care for racial/ethnic minority patients at greater risk of poor care.

Efforts to monitor potential differences in the impact of health care reforms for population subgroups at particular risk.

Nationally-representative databases should be supported to enhance statistical power in comparative analyses of disparities stratified by midlife adults (45–64) vs. older adults (>65) for ongoing monitoring of the health care system, as well as for research. Given the demographic changes of baby boomers entering Medicare, it is particularly important to ensure that available data on the quality of care experiences between midlife and older adults can withstand sophisticated analysis of individual factors. Having the datasets and tools that allow characterization and monitoring of quality differences among those nearing Medicare eligibility has important implications for the Medicare program and its ability to care for the aging population.

Further research is needed to consider patterns of disparities among adults 45–64, and how disparities might change in adults 65 and older.

This report partially addresses the gap with new analyses of nationally available survey data. Additional research should consider factors that contribute to delays in care, particularly for midlife women. These data did not find a consistent effect of race/ethnicity on delays in care, although there were consistent and important racial/ethnic disparities in effectiveness of care measures. More information is needed to understand how individuals perceive the need for care, and how this affects their use of services and reports about access to care.

Studies are needed that focus on the causes of disparities or address reductions in disparities as actual outcomes.

Aside from interventional studies that attempt to address this indirectly, the ability to examine potential sources of disparity directly is limited in disparities literature. Multifactorial, multitarget interventions tailored at vulnerable populations, such as racial minorities, hold promise for targeting different causes of disparities, but more research is needed to explore the mediating factors that lead to the success of promising interventions, in addition to whether successful interventions to reduce disparities can be applied outside an experimental setting.

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