Puerto Rican Medicare Advantage Enrollees Receive Lower Quality Care than Hispanics in States

MedicalResearch.com Interview with:

Maricruz Rivera-Hernandez, PhD Investigator Department of Health Services, Policy & Practice Center for Gerontology and Health Care Research Brown University, Providence, RI

Dr. Rivera Hernandez

Maricruz Rivera-Hernandez, PhD
Department of Health Services, Policy & Practice
Center for Gerontology and Health Care Research
Brown University, Providence, RI 

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Rivera-Hernandez: Over three-quarters of Medicare-eligible residents in Puerto Rico enroll in Medicare Advantage plans, making them the primary source of health care coverage for the island’s seniors. Puerto Rican Medicare Advantage plans have a long history of receiving lower payments than Medicare Advantage plans located in the United States.

The study’s purpose was to compare the quality of care provided to Medicare Advantage enrollees in Puerto Rico with that delivered to Medicare Advantage enrollees in the 50 states and the District of Columbia.

We found significantly worse quality for Puerto Rican Medicare Advantage enrollees compared to their US counterparts for 15 of the 17 quality indicators. These indicators measured whether patients received the recommended treatment and achieved desired outcomes in diabetes care, cardiovascular disease, and cancer screening and whether they received any inappropriate medications in 2011.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Rivera-Hernandez: Medicare Advantage plans in Puerto Rico have substantially worse measured quality than do Medicare Advantage plans in the United States. Some of the biggest disparities we found were for indicators that assessed use of appropriate medications, including use of disease-modifying antirheumatic drug therapy, use of system corticosteroids and bronchodilators in chronic obstructive pulmonary disease.

It may be possible that Puerto Rican patients could not afford to fill prescriptions. The combination of high poverty rates in Puerto Rico and low reimbursement to Puerto Rican Medicare Advantage plans sets up conditions under which medicines may be less subsidized for Puerto Rican residents who lack the financial resources to acquire them.

As of April 4, the Centers for Medicare & Medicaid Services announced changes to increase payments funding to the Medicare program on the island, which may be a first step in improving quality of care to a level comparable to that of the United States.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Rivera-Hernandez: This study demonstrates the importance of including Medicare enrollees from Puerto Rico when studying disparities in the Medicare program. In addition, the study highlights the need for future studies on measures and strategies to improve health care quality in Puerto Rico, specifically after recent changes in Medicare Advantage payments and the island’s ongoing economic difficulties.

MedicalResearch.com: Is there anything else you would like to add?

Dr. Rivera-Hernandez: The data analyzed here showed that Hispanic Medicare Advantage enrollees on the island receive substantially worse quality than Hispanic Medicare Advantage in the 50 states. Policy makers should note this and take action to improve care in Puerto Rico.


Rivera-Hernandez M, Leyva B, Keohane LM, Trivedi AN. Quality of Care for White and Hispanic Medicare Advantage Enrollees in the United States and Puerto Rico. JAMA Intern Med. Published online April 25, 2016. doi:10.1001/jamainternmed.2016.0267.

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Last Updated on April 26, 2016 by Marie Benz MD FAAD