Brian S. Armour and M. Melinda Pitts
Working Paper 2007-18
August 2007

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Almost 20 percent of the total U.S. population and 42 percent of the population over the age of sixty-six are disabled. Research has shown that the presence of a disability can crowd out treatment for medical conditions not necessarily related to the disability and that states that are disproportionately African-American have a lower quality of hospital care. This paper uses quality of care data from the Centers for Medicare and Medicaid Services (CMS) to determine whether disability also explains state-level differences in quality of hospital care. The quality of Medicare beneficiary hospital care was measured using process measures for several medical conditions, including acute myocardial infarction, heart failure, stroke, and pneumonia, that are the leading causes of mortality. We use nonlinear least squares to assess the association between Medicare beneficiary quality of care and state- and medical system–level characteristics. The result for the key variable of interest—disability—reveals that a 1 percent increase in a state's disability rate leads to a 1 percentage point reduction in the score of the state's quality of hospital care. Without explicitly incorporating strategies to eliminate disparities in care incurred by people with disabilities, CMS may not adequately promote the goal of delivering the highest quality of care to all Medicare beneficiaries.

JEL classification: I11

Key words: disability, process measures, Medicare

The authors thank Sarah Dougherty and Suzanne Zurkiya. They also thank Jeff Etchason, Shiferaw Gurmu, Julie Hotchkiss, and John Robertson for helpful comments. The views expressed here are the authors' and not necessarily those of the Centers for Disease Control and Prevention, the Federal Reserve Bank of Atlanta, or the Federal Reserve System. Any remaining errors are the authors' responsibility.

Please address questions regarding content to M. Melinda Pitts, Research Economist and Associate Policy Adviser, Research Department, Federal Reserve Bank of Atlanta, 1000 Peachtree Street, N.E., Atlanta, GA 30309-4470, 404-498-7009, 404-498-8058 (fax),, or Brian S. Armour, Health Scientist, Centers for Disease Control and Prevention.

For further information, contact the Public Affairs Department, Federal Reserve Bank of Atlanta, 1000 Peachtree Street, N.E., Atlanta, Georgia 30309-4470, 404-498-8020.