How Do Gender Differences in Quality of Care Vary Across Medicare Advantage Plans?
Healthcare Effectiveness Data and Information Set (HEDIS) quality measures have long been used to compare care across health plans and to study racial/ethnic and socioeconomic disparities among Medicare Advantage (MA) beneficiaries. However, possible gender differences in seniors’ quality of care have received less attention.
To test for the presence and nature of any gender differences in quality of care across MA Plans, overall and by domain; to identify those most at risk of poor care.
Cross-sectional analysis of individual-level HEDIS measure scores from 23.8 million records using binomial mixed-effect models to estimate the effect of gender on performance. For each measure, we assess variation in gender gaps and their correlation with plan performance.
Beneficiaries from 456 MA plans in 2011–2012 HEDIS data.
Performance on 32 of 34 HEDIS measures which were available in both measurement years. The two excluded measures had mean performance scores below 10%.
Women experienced better quality of care than men for 22/32 measures, with most pertaining to screening or treatment. Men experienced better quality on nine measures, including four related to cardiovascular disease and three to potentially harmful drug-disease interactions. Plans varied substantially in the magnitude of gender gaps for 21/32 measures; in general, the gender gap in quality of care was least favorable to men in low-performing plans.
Women generally experienced better quality of care than men. However, women experienced poorer care for cardiovascular disease-related intermediate outcomes and potentially harmful drug-disease interactions. Quality improvement may be especially important for men in low-performing plans and for cardiovascular-related care and drug-disease interactions for women. Gender-stratified reporting could reveal gender gaps, identify plans for which care varies by gender, and motivate efforts to address faults and close the gaps in the delivery system.
KEY WORDShealth care delivery health services research Medicare performance measurement women’s health
We would like to thank Fergal McCarthy, M.Phil. and Biayna Darabidian, B.A. for assistance with manuscript preparation.
This work was supported by funding from the Centers for Medicare and Medicaid Services (CMS), contract GS-10F-0275P.
Compliance with ethical standards
ARM 2015, Minneapolis, MN.
Conflict of interest
Chloe E. Bird does not have a conflict of interest. Marc N. Elliott does not have a conflict of interest. John L. Adams does not have a conflict of interest. Eric C. Schneider does not have a conflict of interest. David J. Klein does not have a conflict of interest. Jacob W. Dembosky does not have a conflict of interest. Sarah Gaillot does not have a conflict of interest, although please note Sarah is an employee of the sponsoring agency, Centers for Medicare and Medicaid Services. Allen M. Fremont does not have a conflict of interest. Amelia M. Haviland does not have a conflict of interest.
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