Variations in Health Care Quality: Racial, Ethnic, and Economic Disparities in Medicare Fee-for-Service in California

CMRI

This report examines California’s relatively poor performance on standardized quality indicators for care delivered to Medicare fee-for-service beneficiaries by region, race/ethnicity, and socio-economic status.

July 2003

Studies indicate that California has had relatively poor performance in delivering care to Medicare fee-for-service beneficiaries as measured by a standard set of quality indicators used by the Centers for Medicare and Medicaid Services (CMS). For this July 2003 report, CMRI, California's federally designated Quality Improvement Organization, combed more deeply through the data and identified problem areas that could be targeted for improvement.

The study was based on enrollment and claims data from CMS for all Medicare fee-for-service beneficiaries age 65 or older during the period 1998 through 2000. The report also drew on socio-economic data from the U.S. Census Bureau, and, in an effort to place performance indicators in context with clinical outcomes, included cancer statistics from the California Cancer Registry and mortality data from the California Department of Health Services.

The results indicate several sources of variation in care that may contribute to California’s low-quality performance relative to other states. Variation was more pronounced in the racial and socio-economic profiles than in the geographic profile. The study also revealed some provocative disparities in care and confirmed a growing body of evidence that African Americans receive uniformly poorer care than any other subset of the population. However, the broadly exploratory nature of the project is a limitation. More research will be necessary to track down causes of disparities or to implement well-founded solutions.

The PDFs available under Document Downloads summarize the salient portions of the report in narrative and in graphic formats.