Definition of race and ethnicity in older people in Medicare and Medicaid

BACKGROUND: Race and ethnicity are important predictors of health care acce ss and outcomes, but quality of their documentation in the healthcare syste m is often problematic. OBJECTIVES: To study the agreement between Medicare and Medicaid descriptio ns of race and ethnicity in older beneficiaries. DESIGN: Quasiexperimental design in a natural practice setting. SETTING: New Jersey. PARTICIPANTS: 153,241 dually enrolled participants in Medicare and Medicaid . MEASUREMENTS: Agreement rates between administrative databases on recipient s' race and ethnicity. RESULTS: Agreement between Medicare and Medicaid on the recipients' race an d ethnicity was modest (kappa = .58; 95% Ci,.57-.58) for men and women alik e and across different age groups. Depending on whether Medicare or Medicai d was used as the reference standard, the relative agreement rates for race and ethnic group assignments varied. For example, using Medicare as the re ference, the relative agreement rate was 84% for whites, 74% for blacks, 61 % for others, 23% for Hispanics, and only 5% for Asians. Using Medicaid as the reference, a different pattern emerged. However, such gradients of agre ement rates across racial groups were observed in both programs. Medicare a nd Medicaid reported different percentages of all race and ethnicity groups , with Medicaid reporting greater proportions of White and Black beneficiar ies, and Medicare reporting greater proportions of Hispanic, Asian, and Oth er groups. CONCLUSIONS: Depiction of race and ethnicity data in large government healt h insurance programs is approximate at best and often contradictory from on e program to another. This can impede efforts to study the relationship bet ween these important characteristics and health care utilization and outcom es.