Access is better for racial/ethnic elderly in Medicare HMOs--but disparities persist.

Managed care has grown dramatically over the years, first among private employers, then in Medicaid programs (Medi-Cal in California) and in the Medicare system. Today, two in five older persons in California (40%) are in Medicare HMOs at any one time. Nationwide, one in six (17%) among the elderly population is in a Medicare HMO. This Policy Brief reports new findings on access to care of elderly enrollees in Medicare HMOs across four distinct dimensions of access: availability, accessibility, acceptability, and achieved care (Exhibit 1). The analyses compare HMO enrollees with those in traditional fee-for-service programs in California and in the rest of the nation, finding that in both California and in the rest of the country, Medicare HMOs fail to eliminate the access to care gap that Latino and African American elderly persons have with non-Latino white elderly persons. In the case of older Latinos outside of California, Medicare HMOs may even exacerbate the inequalities. Although ethnic/racial gaps in health care access continue in Medicare HMOs, managed care does improve access to health services among the minority elderly in certain significant ways. Most strikingly, in comparison to the traditional Medicare fee-for-service system, HMOs clearly offer better access to care for California’s elderly Latinos. Outside of the state, Medicare HMOs have the greatest positive impact on non-Latino whites (hereafter referred to as “whites”).