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Journal of General Internal Medicine

, Volume 33, Issue 10, pp 1752–1759 | Cite as

How Do Gender Differences in Quality of Care Vary Across Medicare Advantage Plans?

  • Chloe E. Bird
  • Marc N. Elliott
  • John L. Adams
  • Eric C. Schneider
  • David J. Klein
  • Jacob W. Dembosky
  • Sarah Gaillot
  • Allen M. Fremont
  • Amelia M. Haviland
Original Research

Abstract

Background

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.

Objective

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.

Design

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.

Participants

Beneficiaries from 456 MA plans in 2011–2012 HEDIS data.

Main Measures

Performance on 32 of 34 HEDIS measures which were available in both measurement years. The two excluded measures had mean performance scores below 10%.

Key Results

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.

Conclusions

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 WORDS

health care delivery health services research Medicare performance measurement women’s health 

Notes

Contributors

We would like to thank Fergal McCarthy, M.Phil. and Biayna Darabidian, B.A. for assistance with manuscript preparation.

Funding

This work was supported by funding from the Centers for Medicare and Medicaid Services (CMS), contract GS-10F-0275P.

Compliance with ethical standards

Prior presentations

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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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Chloe E. Bird
    • 1
  • Marc N. Elliott
    • 1
  • John L. Adams
    • 2
  • Eric C. Schneider
    • 3
  • David J. Klein
    • 1
  • Jacob W. Dembosky
    • 4
  • Sarah Gaillot
    • 5
  • Allen M. Fremont
    • 1
  • Amelia M. Haviland
    • 4
    • 6
  1. 1.RAND CorporationSanta MonicaUSA
  2. 2.Kaiser Permanente Center for Effectiveness & Safety ResearchPasadenaUSA
  3. 3.The Commonwealth FundNew YorkUSA
  4. 4.RAND CorporationPittsburghUSA
  5. 5.Centers for Medicare & Medicaid ServicesBaltimoreUSA
  6. 6.Carnegie Mellon UniversityPittsburghUSA

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