Disparities in Care Experienced by American Indian and Alaska Native Medicare Beneficiaries. Issue 11 (November 2020)

• Record Type: Journal Article
• Authors: Martino, Steven C.; Elliott, Marc N.; Hambarsoomian, Katrin; Garcia, Andrea N.; Wilson-Frederick, Shondelle; Gaillot, Sarah; Weech-Maldonado, Robert; Haviland, Amelia M.
• Is Part Of: Medical care. Volume 58:Issue 11(2020)
• Publication Date: 2020-11
• Subjects: American Indians and Alaska Natives -- CAHPS -- health disparities -- health care disparities -- Medicare -- patient experience; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000001392
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: Little is known about the health care experiences of American Indians and Alaska Natives (AIANs) due to limited data. Objective: The objective of this study was to investigate the health care experiences of AIAN Medicare beneficiaries relative to non-Hispanic Whites using national survey data pooled over 5 years. Subjects: A total of 1, 193, 248 beneficiaries who responded to the nationally representative 2012–2016 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. Methods: Linear regression models predicted CAHPS measures from race and ethnicity. Scores on the CAHPS measures were linearly transformed to a 0–100 range and case-mix adjusted. Three AIAN groups were compared with non-Hispanic Whites: single-race AIANs (n=2491; 0.4% of the total sample), multiple-race AIANs (n=15, 502; 1.3%), and Hispanic AIANs (n=2264; 0.2%). Results: Among AIAN groups, single-race AIANs were most likely to live in rural areas and areas served by the Indian Health Service; Hispanic AIANs were most likely to be Spanish-language-preferring ( P 's<0.05). Compared with non-Hispanic Whites, single-race AIANs reported worse experiences with getting needed care (adjusted disparity of −5 points; a "large" difference), getting care quickly (−4 points; a "medium" difference), doctor communication (−2 points; a "small" difference), care coordination (−2 points), and customer service (−7 points; P <0.001 for all comparisons). Disparities were similar for Hispanic AIANs but more limited for multiple-race AIANs. Conclusions: Quality improvement efforts are needed to reduce disparities faced by older AIANs. These findings may assist in developing targeted efforts to address cultural, communication, and health system factors presumed to underlie disparities in health care access and customer service. Abstract : Supplemental Digital Content is available in the text.