High-Quality Home Health Agencies Are ‘Out of Reach’ for Medicare Beneficiaries of Color

New research from the University of Minnesota School of Public Health (SPH) examines the association between race and income of home-based Medicare patients and the quality of care they receive from home health agencies .

The study, led by SPH Assistant Professor Shekinah Fashaw-Walters, used 2016 Medicare data to examine how racial, ethnic, and socioeconomic status at the individual and neighborhood level is associated with agency use. High quality. The quality of home health care agencies was determined using a five-star federal rating system. “High quality” agencies received 3.5 stars or more.

“The inequalities we find in this study are most likely due to racism, especially since we found that much of the disparity is related to neighborhood-level factors,” Fashaw-Walters said.

The study revealed that:

  • Black and Hispanic patients had a 2.2% and 2.5% lower odds of using high-quality home health agencies, respectively, compared to their white counterparts in the same neighborhoods.
  • Low-income patients had a 1.2% lower likelihood of using a high-quality home health agency compared to their higher-income counterparts, and patients residing in neighborhoods with higher proportions of residents marginalized had a lower likelihood of using a high-quality agency.
  • Some 40-77% of disparities in the use of quality agencies were attributable to neighborhood-level factors.

This study serves as a call to action for policymakers and the Medicare home health program to urgently consider reducing racial and socioeconomic disparities in access to high-quality home health care. . Mitigating these disparities will require policies that dismantle the structural and institutional barriers of racism, provide incentives to serve the underserved, and reallocate resources to the most vulnerable areas and patient populations. Ensuring equitable access to quality care for all older people means taking the necessary steps to bring high-quality home health agencies within reach of the most marginalized.

“Changes are needed in the Medicare home health program to ensure equitable access for all Medicare beneficiaries,” Fashaw-Walters said. “Changes should be prioritized before payment-altering initiatives, such as home health value-based purchases, are fully implemented, as similar market-based reforms in the past exacerbate health disparities.”

Fashaw-Walters plans to conduct future research focused on the impact of market-based reforms, such as public reporting and the home health value-based purchasing program, and agency performance to understand how inequities in access to home health care contribute to inequities in clients’ health and well-being.


This study was supported by the National Institute on Aging.

About the School of Public Health
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