Medicare's race, ethnic data often undercounts minority populations

The information critical to a nationwide priority of reducing healthcare disparities among minorities is incomplete and inaccurate, according to a new Rutgers study.

Published in Medical Care Research and Review and Medical Care, the study compared Medicare beneficiaries' race and ethnicity data from the two most widely-used administrative data sources, to data sources that include beneficiaries' self-reported race and ethnicity information.

It found that in 19 states, the administrative data sources significantly undercounted the proportion of people who were Hispanic. It discovered even more widespread undercounting of Asian American, Native Hawaiian, Pacific Islander, and American Indian populations.

The study was led by Olga Jarrín Montaner, assistant professor at Rutgers School of Nursing and Institute for Health, Health Care Policy, and Aging Research and Irina Grafova, assistant professor at Rutgers School of Public Health.

WHAT'S THE IMPACT

Since the United States' population of older adults is not just rapidly growing but also becoming more racially and ethnically diverse, collecting and using accurate data on this population's race and ethnicity is needed to identify disparities in healthcare access and quality of care, and is vital for identifying systemic barriers to improving minority health outcomes, the authors said.

The inaccuracy of state-level data regarding race and ethnicity was troubling. In 19 states, 20% of Medicare beneficiaries identifying as Hispanic were classified as belonging to another ethnic group. In another 24 states, the situation was even worse for Native Americans and Alaskans, with more than 80% of Medicare beneficiaries in that group being misclassified. In most states, at least a quarter of Asian Americans and Pacific Islanders were misclassified.

Medicare requires the collection of self-reported race and ethnicity data during standardized assessments in home health care and other care settings and should be used whenever possible by researchers who are documenting racial disparities and the impact of racism on healthcare use and outcomes, authors said.

They suggest that the Centers for Medicare and Medicaid Services incorporate these findings into its methodology to improve the accuracy of its racial and ethnic data. This would help the agency estimate health disparities among minority populations, which in turn would inform better public health and policy in the future. It could also help to shed light on disparities in outcomes, which is being seen currently during the COVID-19 pandemic.

THE LARGER TREND

There's no doubt that COVID-19 has highlighted disparities in healthcare that cuts across racial lines. Medicare claims data, for example, shows Blacks were hospitalized with COVID-19 at a rate nearly four times higher than whites.

Blacks had the highest hospitalization rate, with 465 per 100,000. Hispanics had 258 hospitalizations per 100,000. Asians had 187 per 100,000, and whites had 123 per 100,000.

The disparities go beyond race and ethnicity and suggest the impact of social determinants of health, particularly socioeconomic status, according to the Centers for Medicare and Medicaid Services in a snapshot of the impact of the COVID-19 pandemic on the Medicare population.

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Email the writer: jeff.lagasse@himssmedia.com