Medicare patients nationwide have low rates of preventive care visits, with the lowest rates found in older adults of minority race/ethnicity, finds a study in the September issue of Medical Care.
Lower use of the Medicare annual wellness visit, or AWV, by non-white patients is partially explained by income and education -- suggesting that the difference is related to factors associated with racial and ethnic inequality,
The study included data on nearly 15,000 Medicare fee-for-service beneficiaries, aged 66 or older, participating in the nationally representative Medicare current beneficiary survey from 2011 to 2013.
Introduced in 2011 as part of the Affordable Care Act, the AWV seeks to prevent disease and disability by increasing preventive services such as screening and vaccinations, based on the patient's current health and risk factors. The AWV is available once yearly, with no out-of-pocket costs to patients. It's different from the "Welcome to Medicare" visit, which is only available in the first year of enrollment.
Because minority patients are more likely to have lower income and less likely to have supplemental insurance, the AWV has the potential to help to reduce racial/ethnic health disparities.
Yet throughout the study period, use of the AWV was low. In 2011, only 8.1 percent of Medicare beneficiaries used the AWV. In 2011 the rate was highest for white patients at 8.5 percent, and lowest for black patients,at 4.5 percent.
By 2013, the overall rate of AWV use increased to 13.4 percent. The greatest increase was seen in black patients, for whom the rate of AWV use nearly tripled to 15.4 percent.
Overall, AWV use was lower in racial/ethnic minority groups -- black, Hispanic, and "other race" -- compared to white beneficiaries. After adjustment for income and education, the racial/ethnic group was no longer a statistically significant factor, suggesting culprits long associated with racial and ethnic differences, including access to care, care preferences and knowledge of the AWV.
Use of the AWV was lower for beneficiaries living in rural area and higher for those who had a usual place for healthcare, other than the emergency room.