Objective: Examine racial/ethnic disparities in 30-day readmission and frequent hospitalizations among Medicare beneficiaries with dementia in traditional Medicare (TM) vs. Medicare Advantage (MA).
Method: In this case-control study, we used 2018-2019 TM and MA claims data. Participants included individuals 65+ with two years of continuous enrollment, diagnosis of dementia, a minimum of four office visits in 2018, and at least one hospitalization in 2019, [cases: TM (n=36,656); controls: MA (n=29,366)]. We conducted matching based on health need variables and applied generalized linear models adjusting for demographics, health-related variables, and healthcare encounters.
Results: TM was associated with higher odds of 30-day readmission [OR=1.07 (CI:1.02-1.12)] and frequent hospitalizations [OR=1.10 (CI: 1.06-1.14)] compared to MA. Hispanic and Black enrollees in TM had higher odds of frequent hospitalizations compared with Hispanic and Black enrollees in MA, respectively [OR=1.35 (CI: 1.19-1.54)] and [OR=1.26 (CI: 1.13-1.40)]. MA was associated with lower Hispanic-White and Black-White disparities in frequent hospitalizations by 5.8 (CI: -.09 - -.03) and 4.4 percentage points (PP) (CI: -.07 - -.02), respectively. For 30-day readmission, there was no significant difference between Black enrollees in TM and MA [OR=1.04 (CI: .92 -1.18)], but Hispanic enrollees in TM had higher odds of readmission than Hispanics in MA [OR=1.23 (CI: 1.06-1.43)]. MA was associated with a lower Hispanic-White disparity in readmission by 1.9 PP (CI: -.004 - -0.01).
Discussion: MA vs. TM was associated with lower risks of 30-day readmission and frequent hospitalizations. Moreover, MA substantially reduced Hispanic-White and Black-White disparities in frequent hospitalizations compared with TM.
Keywords: Adverse Health Events; Dementia; Disparity; Medicare Options.
© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.