Feature Story

Medical disparities for elderly Medicare beneficiaries are narrowing

A new study shows that an increasing percentage of black enrollees in Medicare managed care plans are being screened for breast cancer or treated for diabetes or heart disease in accordance with nationally recognized quality measures. The study was supported in part by the Agency for Healthcare Research and Quality (HS10803).

Researchers at Brigham and Women's Hospital and Harvard Medical School found that the percentages of black enrollees with diabetes who had their low-density lipoprotein (LDL) or "bad cholesterol" levels measured rose from 61 percent in 1999 to 92 percent in 2003—a 31 percent gain. The percentage of black enrollees with diabetes who had their LDL levels controlled increased even more—by 46 percent (from 23 percent in 1999 to 66 percent in 2003). These gains resulted in a narrowing of the gaps between blacks and whites for both LDL testing (from 9 percent to 2 percent) and LDL control (from 13 percent to 17 percent). The rates of LDL testing and control increased for whites as well over the study period.

Between 1997 and 2002, the percentage of enrollees prescribed a beta-blocker drug within 7 days of hospital discharge following a heart attack, heart bypass surgery, or angioplasty rose from 64 percent to 93 percent for blacks and 76 percent to 94 percent for whites. This progress resulted in many more patients getting optimal care, and also narrowed the gap from 12 percentage points to only 1 percentage point between blacks and whites with cardiovascular disease.

Blacks fell further behind whites on only one quality measure between 1999 and 2002. The proportion of black enrollees with diabetes who had their blood sugar levels controlled according to nationally recognized clinical performance standards rose by only 8 percentage points (from 67 percent to 75 percent), while for whites the numbers rose 11 percentage points (from 71 percent to 82 percent).

The researchers analyzed Health Plan Employer Data and Information Set (HEDIS) measures involving 1.5 million individuals enrolled in 183 Medicare managed care plans over the study period. Health plans participating in Medicare have been required to submit publicly reported data using specific HEDIS quality indicators since 1997.

Details are in "Trends in the quality of care and racial disparities in Medicare managed care," by Amal N. Trivedi, M.D., M.P.H., Alan M. Zaslavsky, Ph.D., Eric C. Schneider, M.D., M.Sc., and John Z. Ayanian, M.D., M.P.P., in the August 18, 2005, New England Journal of Medicine 353, pp. 692-700.

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