Strengthening Medicare’s Role in Reducing Racial and Ethnic Health Disparities

October 2006

Disparities in health care for racial and ethnic minorities and low-income persons pose a pressing national problem. This report of a study panel convened by the National Academy of Social Insurance examines Medicare’s role in moving towards a solution.

Disparities in access to health care and medical treatment have been documented again and again. Even among Medicare beneficiaries, marked disparities persist in health care, although disparities in the use of health care services by race and income have diminished since Medicare’s implementation. Minorities also fall short of whites on many measures of health status.

Because of its dominant influence over the entire health care sector, Medicare has unique opportunities to, and responsibility for, reducing racial and ethnic health disparities. Along with its ability to improve the care provided to its 9 million minority beneficiaries, Medicare’s leverage as the largest purchaser and regulator of health care provides an ability to achieve reductions in disparities. As a social insurance program, Medicare has the responsibility to ensure that all those who have contributed to the program receive appropriate care on a fair and nondiscriminatory basis.

The study panel concludes that Medicare is obligated to take the lead in reducing disparities—both for its beneficiaries and throughout the health system—and makes 17 recommendations to those who set policy for and administer the Medicare program. The panel’s recommendations fall into five categories:

• Improving the quality of clinical care,
• Increasing access to care,
• Educating health professionals to improve diversity and cultural competence,
• Holding health care providers responsible for reducing disparities, and
• Making the reduction of disparities a top administrative priority and focus.In each of these areas, Medicare has tools that it can use to help reduce disparities. The panel’s final report, Strengthening Medicare’s Role in Reducing Racial and Ethnic Health Disparities (downloadable below), details both the recommendations and their rationale.As part of its work, the panel also published three issue briefs and five working papers:
  • Medicare, the National Quality Infrastructure, and Health Disparities, Medicare Brief No. 14, by Lawrence P. Casalino,
  • Improving Medicare’s Data on Race and Ethnicity, Medicare Brief No. 15, by A. Marshall McBean,
  • Strengthening Medicare’s Role in Reducing Racial and Ethnic Health Disparities,
    (PDF Summary of the Full Report). Medicare Brief No. 16
  • Racial and Ethnic Disparities in Medicare: What the Department of Health and Human Services and the Center for Medicare and Medicaid Services Can, and Should, Do, by Timothy Stoltzfus Jost,
  • CMS’ Programs and Initiatives to Reduce Racial and Ethnic Disparities in Medicare, by Ellen O’Brien,
  • Individual Physicians or Organized Processes: How Can Disparities in Clinical Care be Reduced?, by Lawrence P. Casalino,
  • Medicare Race and Ethnicity Data, by A. Marshall McBean, and
  • A New Strategy to Combat Racial Inequality in American Health Care Delivery by Dayna Bowen Matthew.

  The Robert Wood Johnson Foundation provided the primary financial support for this project. Additional funding was provided by The California Endowment and the Joint Center for Political and Economic Studies.