Racial/Ethnic Disparities in Medicare Part D Experiences

Haviland, Amelia; Elliott, Marc N.; Weech‐Maldonado, Robert; Hambarsoomian, Katrin; Orr, Nate; Hays, Ron D.

doi:10.1097/mlr.0b013e3182610aa5

Cited by 39 publications

(45 citation statements)

References 20 publications

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“…31,32 In Medicare beneficiaries, healthy African Americans reported diminished access to care compared with their Caucasian counterparts on several secondary measures, such as customer service and prescription drug information, as well as some tertiary measures, such as immunization for pneumonia. 33 African Americans also reported greater challenges in obtaining prescription medications through Medicare Part D. 34 In our study of a slightly younger, community-based population, there were no racial differences in rates of emergency department use after income level or insurance status was considered. However, we have no data on outpatient care use and, thus, cannot directly assess the association between health care use and AKI risk.…”

Section: Discussionmentioning

confidence: 76%

Explaining the Racial Difference in AKI Incidence

Grams

Matsushita²,

Sang³

et al. 2014

Journal of the American Society of Nephrology

127

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African Americans face higher risk of AKI than Caucasians. The extent to which this increased risk is because of differences in clinical, socioeconomic, or genetic risk factors is unknown. We evaluated 10,588 African-American and Caucasian participants in the Atherosclerosis Risk in Communities study, a community-based prospective cohort of middle-aged individuals. Participants were followed from baseline study visit (1996)(1997)(1998)(1999) to first hospitalization for AKI (defined by billing code), ESRD, death, or December 31, 2010. African-American participants were slightly younger (61.7 versus 63.1 years, P,0.001), were more often women (64.5% versus 53.2%, P,0.001), and had higher baseline eGFR compared with Caucasians. Annual family income, education level, and prevalence of health insurance were lower among African Americans than Caucasians. The unadjusted incidence of hospitalized AKI was 7.4 cases per 1000 person-years among African Americans and 5.8 cases per 1000 person-years among Caucasians (P=0.002). The elevated risk of AKI among African Americans persisted after adjustment for demographics, cardiovascular risk factors, kidney markers, and time-varying number of hospitalizations (adjusted hazard ratio, 1.20; 95% confidence interval [95% CI], 1.01 to 1.43; P=0.04); however, accounting for differences in income and/or insurance by race attenuated the association (P.0.05). High-risk APOL1 variants did not associate with AKI among African Americans (demographic-adjusted hazard ratio, 1.07; 95% CI, 0.69 to 1.65; P=0.77). In summary, the higher risk of AKI among African Americans may be related to disparities in socioeconomic status.

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Section: Discussionmentioning

confidence: 76%

Explaining the Racial Difference in AKI Incidence

Grams

Matsushita²,

Sang³

et al. 2014

Journal of the American Society of Nephrology

127

View full text Add to dashboard Cite

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“…First, our data and recent literature (Haviland et al, 2012) show that after 2006, Hispanics were primarily covered by Part D Medicare Advantage prescription drug (MA-PD) plans, significantly more so than Whites and Blacks (41% vs. 33% and 29% among Blacks and Whites, respectively, in our sample). Most MA-PD plan enrollees were enrolled in an MA plans prior to 2006 (Neuman et al, 2007); these beneficiaries generally experienced a smoother transition to drug coverage with the advent of Part D, thanks to the more seamless integration of the new benefit into the already existing managed care structure (Haviland et al, 2012).…”

Section: Discussionmentioning

confidence: 89%

Impact of Medicare Part D on Racial Disparities in Adherence to Cardiovascular Medications Among the Elderly

et al. 2015

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Medicare Part D improved medication adherence among the elderly, but to date, its effect on disparities in adherence remains unknown. We estimated Part D impact on racial/ethnic disparities in adherence to cardiovascular medications among seniors, using pooled data from the Medical Expenditure Panel Survey (2002-2010) on 14,221 Medicare recipients (65+ years) and 3,456 near-elderly controls (60-64 years). Study sample included White, Black, or Hispanic respondents who used at least one cardiovascular medication. Twelve-month adherence was measured as having an overall proportion of days covered ≥80%. Adherence disparities were defined according to the Institute of Medicine framework. Using difference-in-differences logistic regression, we found Part D to be associated with a 16-percentage-point decrease in the White-Hispanic disparity in overall adherence among seniors, net of the change among controls. Black-White disparities worsened only among men, by 21 percentage points. Increasing access and improving quality of medication use among disadvantaged seniors should remain a policy priority.

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“…240 Minority Medicare beneficiaries are less likely to receive Part D prescription drug benefits than whites, with the highest disparity affecting Spanish-preferring Latinos. 241 The AHA supports reimbursement and minimal copays for preventive services. 242 The impact of expanded, affordable insurance and improved access to health care on HBP and its sequelae is uncertain.…”

Section: Increase Access To Appropriate Treatmentsmentioning

confidence: 99%

Evidence-Based Policy Making: Assessment of the American Heart Association’s Strategic Policy Portfolio

Goldstein¹,

Antman²,

Arnett³

et al. 2016

Circulation

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Background-American Heart Association (AHA) public policy advocacy strategies are based on its Strategic Impact Goals.The writing group appraised the evidence behind AHA's policies to determine how well they address the association's 2020 cardiovascular health (CVH) metrics and cardiovascular disease (CVD) management indicators and identified research needed to fill gaps in policy and support further policy development. Methods and Results-The AHA policy research department first identified current AHA policies specific to each CVH metric and CVD management indicator and the evidence underlying each policy. Writing group members then reviewed each policy and the related metrics and indicators. The results of each review were summarized, and topic-specific priorities and overarching themes for future policy research were proposed. There was generally close alignment between current AHA policies and the 2020 CVH metrics and CVD management indicators; however, certain specific policies still lack a robust evidence base. For CVH metrics, the distinction between policies for adults (age ≥20 years) and children (<20 years) was often not considered, although policy approaches may differ importantly by age. Inclusion of all those <20 years of age as a single group also ignores important differences in policy needs for infants, children, adolescents, and young adults. For CVD management indicators, specific quantitative targets analogous to criteria for ideal, intermediate, and poor CVH are lacking but needed to assess progress toward the 2020 goal to reduce deaths from CVDs and stroke. New research in support of current policies needs to focus on the evaluation of their translation and implementation through expanded application of implementation science. Focused basic, clinical, and population research is required to expand and strengthen the evidence base for the development of new policies. Evaluation of the impact of targeted © 2016 American Heart Association, Inc.Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIR.0000000000000410The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This policy statement was approved by the Advocacy Coordinating Committee February 23, 2016, and the American Heart Association Executive Committee on February 23, 2016. A copy of the document is available at http://professional.heart.org/statements by using either "Search for Guidelines & Statements" or the "Browse by Topic" area. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.The American Heart Association requests that this document be cited as follows: Labarthe DR, Goldstein LB,...

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Racial/Ethnic Disparities in Medicare Part D Experiences

Cited by 39 publications

References 20 publications

Explaining the Racial Difference in AKI Incidence

Explaining the Racial Difference in AKI Incidence

Impact of Medicare Part D on Racial Disparities in Adherence to Cardiovascular Medications Among the Elderly

Evidence-Based Policy Making: Assessment of the American Heart Association’s Strategic Policy Portfolio

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