Variation in racial and ethnic differences in consumer assessments of health care

Background: Prior studies have documented significant racial and ethnic disparities in health and healthcare, but data about disparities from consumer assessments of care are inconsistent. Objective: To examine racial/ethnic differences in consumer assessments and explore variation in such differences across health plans. Methods: Data included 160 694 Consumer Assessment of Health Plans Surveys (CAHPS) responses from 307 commercial health plans and 177 489 Medicare beneficiaries in 308 Medicare+Choice managed care plans collected in 1999. We compared adjusted mean CAHPS global rating and composite scores as well as access to and use of care reported by whites, blacks, Hispanics, and Asians. We assessed variation in the differences between plan means for whites and blacks and between whites and Hispanics. Results: Three minority groups rated their health plans higher than whites on at least 1 measure. Blacks rated their care and doctors higher than whites, while Asians rated their care and doctors lower than whites. Blacks reported better experience with care than whites, but Hispanics and Asians reported worse experience than whites. However, all minority groups reported significantly larger problems with access to and less use of healthcare. The differences between blacks and whites, and blacks and Hispanics in CAHPS measures and access/use measures varied greatly from plan to plan. Conclusions: Significant race/ethnic differences in experience with, access to, and use of care exist in health plans. Substantial variation in racial differences suggests compromised quality of healthcare and opportunities for quality improvement.