Despite modest differences in care between white and Hispanic Medicare Advantage enrollees in the U.S., a recent study found MA enrollees in Puerto Rico receive "substantially" worse care — so much so that the program would require major efforts to bring it up to standards equivalent to the U.S.
Prior studies have found lower quality of care in Puerto Rico and lower quality of care for racial minorities in the MA program. Published in JAMA, the most recent study analyzed a cross section of MA enrollees in 2011 to determine if disparities exist dependent on Puerto Rican residence.
Researchers compared 17 performance measures and found Hispanic MA enrollees received significantly worse care across age, sex and income level than their white and Hispanic counterparts in the U.S. for 15 of those measures. The largest disparities were found in appropriate drug use for coronary artery disease, rheumatoid arthritis and chronic obstructive pulmonary disease.
The study notes that about one-quarter of the MA program's Hispanic enrollees live in Puerto Rico, and more Hispanic enrollees live in Puerto Rico than in any other state. Thus, as the MA program makes efforts to understand and address ethnic disparities in care, Puerto Rico must be part of the solution, according to the study authors. Puerto Rico's MA disparity needs attention in particular because the island has a poverty rate three times higher than the U.S. On top of that, its MA payment rates are 30 percent lower than Alabama's — the state with the lowest payment rate — and further cuts to the plans may be implemented this year as the Affordable Care Act aligns MA and traditional Medicare payments, according to the study authors.
More articles on payer issues:
UnitedHealth to leave Iowa ACA marketplace
As insurers lose on the exchanges, ACA premiums expected to rise
HCA, BCBS of Texas renew contract