Language and Regional Differences in Evaluations of Medicare Managed Care by Hispanics

The Medicare+Choice program was aimed at increasing the managed care options among Medicare beneficiaries. Although the program has not achieved the enrollment envisioned by policy makers, there were approximately 5 million (12 percent) Medicare beneficiaries enrolled in Medicare+Choice in 2004 (KFF 2005). This program has been particularly attractive to racial/ethnic minority beneficiaries. Thorpe, Atherly, and Howell (2002) found that 52 percent of Hispanic and 40 percent of African-American beneficiaries were enrolled in Medicare+Choice in 2002.1 Furthermore, six markets (South California, North California, Philadelphia, South Florida, New Jersey, and New York City) with a high concentration of racial/ethnic minorities accounted for about 41 percent Medicare+Choice enrollment in 2002. The popularity of Medicare managed care among racial/ethnic minorities may be due to the relatively lower out-of-pocket costs of managed care (especially HMOs) compared with the traditional fee-for-service program. This is particularly appealing to racial/ethnic minorities because they are overrepresented among the lowest income Medicare beneficiaries. As more vulnerable populations enroll in managed care plans it becomes essential to assess their experiences with care. Restricted provider networks, utilization review, specialist referrals, and other cost-containment mechanisms may be particularly challenging for vulnerable populations. The Centers for Medicare and Medicaid Services (CMS) uses the Consumer Assessments of Healthcare Providers and Systems (CAHPS®) Medicare Managed Care Survey since 1997 to survey Medicare beneficiaries enrolled in managed care plans (Langwell and Moser 2002). Studies contrasting Spanish- and English-speaking Hispanics have found Spanish speakers to be less satisfied with the care received and with provider communication (David and Rhee 1998; Carrasquillo et al. 1999; Morales et al. 1999). Similarly, Weech-Maldonado et al. (2001, 2003, 2004) found that among Hispanics, language barriers had a larger negative impact on assessments of Medicaid managed care than ethnicity. The extent to which there are regional variations in CAHPS scores may be indicative of geographic disparities in patient experiences with Medicare managed care. Prior studies have shown regional variations in the CAHPS scores (Zaslavsky et al. 2000, 2004), however, there have been no studies examining regional variations in Hispanic assessments of care. To date only two studies have examined racial/ethnic differences in Medicare managed care CAHPS (Lurie et al. 2003; Fongwa et al. 2006). Lurie et al. (2003) study found that compared with whites, Hispanics had less positive assessments of getting needed care, timeliness of care, and staff helpfulness, but higher ratings for their health plan. However, this study did not analyze language or regional differences in Hispanic assessments of Medicare managed care. Fongwa et al. (2006) found higher missing data rates and lower plan-level reliabilities for African-American respondents when compared with white respondents. However, internal consistency reliability estimates were similar for both groups.