Effects of Part D Star Ratings on racial and ethnic disparities in health care costs
Background: Racial/ethnic minorities are less likely than non-Hispanic White (White) patients to be included in the Medicare Part D Star Ratings measure assessment due to the restrictive inclusion criteria for the measures. Objective: This paper examined the effects of racial/ethnic disparities in t...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | Exploratory Research in Clinical and Social Pharmacy |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667276623000318 |
| _version_ | 1797837686051962880 |
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| author | Chi Chun Steve Tsang Yongbo Sim Michael L. Christensen Junling Wang |
| author_facet | Chi Chun Steve Tsang Yongbo Sim Michael L. Christensen Junling Wang |
| author_sort | Chi Chun Steve Tsang |
| collection | DOAJ |
| description | Background: Racial/ethnic minorities are less likely than non-Hispanic White (White) patients to be included in the Medicare Part D Star Ratings measure assessment due to the restrictive inclusion criteria for the measures. Objective: This paper examined the effects of racial/ethnic disparities in the measure assessment in Part D Star Ratings on disparities in healthcare costs among patients with Alzheimer's disease and related dementias (ADRD). Methods: This cross-sectional study analyzed 2017 Medicare data. Proportions of Beneficiaries with ADRD were categorized into the included and excluded groups based on the inclusion criteria for the calculation of medication adherence measures in Star Ratings. Outcomes included costs for medications, physician visits, emergency room (ER) visits, and total costs. A generalized linear model was employed to compare costs across racial/ethnic groups. To explore the differential disparities in healthcare costs between the 2 groups, interaction terms between dummy variables for being excluded from the measure calculation and racial/ethnic minorities were included in the models. Results: The patterns of racial/ethnic disparities in healthcare costs found in this study were generally consistent with expectations, with some exceptions. For example, compared with White patients, in the hyperlipidemia cohort, the physician visit cost for Black patients among the included group was 31% lower (cost ratio or CR = 0.69, 95% CI = 0.67–0.72); in the hypertension cohort, the hospitalization cost for Blacks among the excluded group was 15% higher (CR = 1.15, 95% CI = 1.12–1.19). More importantly, exclusion from measurement assessments was associated with differential cost disparities. For example, compared with individuals included in the measure assessment for hypertension, the Black-White disparities in costs for hospitalization and total healthcare were 30% higher (CR = 1.30, 95% CI = 1.26–1.34), and 10% higher (CR = 1.10; 95% CI = 1.08–1.12), respectively, among the excluded group. Conclusions: Medicare Part D Star Ratings may be associated with aggravated racial/ethnic disparities in healthcare costs in the Medicare Part D population. |
| first_indexed | 2024-04-09T15:29:46Z |
| format | Article |
| id | doaj.art-15812d9665e7412398c7e79e189d32ce |
| institution | Directory Open Access Journal |
| issn | 2667-2766 |
| language | English |
| last_indexed | 2024-04-09T15:29:46Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Exploratory Research in Clinical and Social Pharmacy |
| spelling | doaj.art-15812d9665e7412398c7e79e189d32ce2023-04-28T08:56:53ZengElsevierExploratory Research in Clinical and Social Pharmacy2667-27662023-03-019100250Effects of Part D Star Ratings on racial and ethnic disparities in health care costsChi Chun Steve Tsang0Yongbo Sim1Michael L. Christensen2Junling Wang3Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USADepartment of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USADepartment of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USACorresponding author.; Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USABackground: Racial/ethnic minorities are less likely than non-Hispanic White (White) patients to be included in the Medicare Part D Star Ratings measure assessment due to the restrictive inclusion criteria for the measures. Objective: This paper examined the effects of racial/ethnic disparities in the measure assessment in Part D Star Ratings on disparities in healthcare costs among patients with Alzheimer's disease and related dementias (ADRD). Methods: This cross-sectional study analyzed 2017 Medicare data. Proportions of Beneficiaries with ADRD were categorized into the included and excluded groups based on the inclusion criteria for the calculation of medication adherence measures in Star Ratings. Outcomes included costs for medications, physician visits, emergency room (ER) visits, and total costs. A generalized linear model was employed to compare costs across racial/ethnic groups. To explore the differential disparities in healthcare costs between the 2 groups, interaction terms between dummy variables for being excluded from the measure calculation and racial/ethnic minorities were included in the models. Results: The patterns of racial/ethnic disparities in healthcare costs found in this study were generally consistent with expectations, with some exceptions. For example, compared with White patients, in the hyperlipidemia cohort, the physician visit cost for Black patients among the included group was 31% lower (cost ratio or CR = 0.69, 95% CI = 0.67–0.72); in the hypertension cohort, the hospitalization cost for Blacks among the excluded group was 15% higher (CR = 1.15, 95% CI = 1.12–1.19). More importantly, exclusion from measurement assessments was associated with differential cost disparities. For example, compared with individuals included in the measure assessment for hypertension, the Black-White disparities in costs for hospitalization and total healthcare were 30% higher (CR = 1.30, 95% CI = 1.26–1.34), and 10% higher (CR = 1.10; 95% CI = 1.08–1.12), respectively, among the excluded group. Conclusions: Medicare Part D Star Ratings may be associated with aggravated racial/ethnic disparities in healthcare costs in the Medicare Part D population.http://www.sciencedirect.com/science/article/pii/S2667276623000318DisparitiesHealthcare costsDifferential costsStar RatingsAlzheimer's disease and related dementiasMeasure calculation |
| spellingShingle | Chi Chun Steve Tsang Yongbo Sim Michael L. Christensen Junling Wang Effects of Part D Star Ratings on racial and ethnic disparities in health care costs Exploratory Research in Clinical and Social Pharmacy Disparities Healthcare costs Differential costs Star Ratings Alzheimer's disease and related dementias Measure calculation |
| title | Effects of Part D Star Ratings on racial and ethnic disparities in health care costs |
| title_full | Effects of Part D Star Ratings on racial and ethnic disparities in health care costs |
| title_fullStr | Effects of Part D Star Ratings on racial and ethnic disparities in health care costs |
| title_full_unstemmed | Effects of Part D Star Ratings on racial and ethnic disparities in health care costs |
| title_short | Effects of Part D Star Ratings on racial and ethnic disparities in health care costs |
| title_sort | effects of part d star ratings on racial and ethnic disparities in health care costs |
| topic | Disparities Healthcare costs Differential costs Star Ratings Alzheimer's disease and related dementias Measure calculation |
| url | http://www.sciencedirect.com/science/article/pii/S2667276623000318 |
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