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National Healthcare Disparities Report, 2003

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Chapter 4. Access to Health Care (continued)

Tables

Table 1. Racial and Ethnic Differences in Entry into the Health Care System

Measure Racial Difference1 Ethnic Difference2
Black Asian NHOPI AI/AN >1 Race NHB Hispanic
Health Insurance Coverage
% of persons, ages <65, with health insurance3 Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons, ages <65, with public health insurance only3 Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Data are collected but do not meet criteria for statistical reliability Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons, ages <65, with any private health insurance3 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons, ages 65+, with any private health insurance3 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons uninsured all year4 Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care4 Selected population receives worse quality care than the comparison population   Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons uninsured all year4 Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care4 Selected population receives worse quality care than the comparison population   Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons uninsured all year4 Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care4 Selected population receives worse quality care than the comparison population   Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
Usual Source of Care
% of persons who have a specific source of ongoing care3 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons in fair or poor health who have a specific source of ongoing care3 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons with a hospital, emergency room, or clinic as source of ongoing care3 Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Data are collected but do not meet criteria for statistical reliability Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons with a community health center as source of ongoing care3 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability   Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons without a usual source of care who indicate a financial or insurance reason for not having a source of care4 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care4 Data are collected but do not meet criteria for statistical reliability   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of persons who have a usual primary care provider 4 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population4 Selected population and comparison population receive about same quality of health care   Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of adults who report very little or no choice in source of care5 Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of adults who have had a regular doctor for more than 5 years5 Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population

1Compared with whites.
2 Compared with non-Hispanic whites.
3 Source: National Center for Health Statistics, National Health Interview Survey, 2000.
4 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1999. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asians or Pacific Islanders. This source did not collect information for >1 race.
5 Source: The Commonwealth Fund Health Care Quality Survey, 2001. This source did not collect information for >1 race separately.

Table 1. Racial and Ethnic Differences in Entry into the Health Care System (continued)

Measure Racial Difference1 Ethnic Difference2
Black Asian NHOPI AI/AN >1 Race NHB Hispanic
Patient Perceptions of Need
% of families that experience difficulties or delays in obtaining health care or do not receive needed care3 Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care3 Data are collected but do not meet criteria for statistical reliability   Selected population receives better quality care than the comparison population Selected population receives worse quality care than the comparison population
% of families that experience difficulties or delays in obtaining health care due to financial or insurance reasons3 Selected population and comparison population receive about same quality of health care Data are collected but do not meet criteria for statistical reliability3 Data are collected but do not meet criteria for statistical reliability   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of families that did not receive a doctor's care or prescription medications because the family needed the money3 Selected population and comparison population receive about same quality of health care Data are collected but do not meet criteria for statistical reliability3 Data are collected but do not meet criteria for statistical reliability   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of families not very satisfied that they can get health care if they need it3 Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population3 Data are collected but do not meet criteria for statistical reliability   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of persons who can always get appointments for routine care as soon as wanted4 Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population4 Data are collected but do not meet criteria for statistical reliability   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of persons who can always get care for illness or injury as soon as wanted4 Selected population and comparison population receive about same quality of health care Data are collected but do not meet criteria for statistical reliability4 Data are collected but do not meet criteria for statistical reliability   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population

1Compared with whites.
2 Compared with non-Hispanic whites.
3 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1999. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asians or Pacific Islanders. This source did not collect information for >1 race.
4 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2000. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asians or Pacific Islanders. This source did not collect information for >1 race.

Key to Access to Health Care Tables:

Solid black circle: Selected population and comparison population receive about same quality of health care

Circle with solid black half on top, and white half on bottom: Selected population receives better quality care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives worse quality care than the comparison population

Clear circle: Data are collected but do not meet criteria for statistical reliability

NHOPI=Native Hawaiian or Other Pacific Islander; AI/AN=American Indian or Alaska Native; NHB=non-Hispanic black

Table 2. Socioeconomic Differences in Entry into the Health Care System

Measure Income Difference1 Educational Difference2 Insurance Difference3
<100% 100-199% 200-399% <HS HS Grad Uninsured
Health Insurance Coverage
% of persons, ages <65, with health insurance4 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population  
% of persons, ages <65, with public health insurance only4 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population  
% of persons, ages <65, with any private health insurance4 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population  
% of persons, ages 65+, with any private health insurance4 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population  
% of persons uninsured all year5 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population  
% of persons with any period of uninsurance during the year5 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population  
% of persons with any period of public insurance during the year5 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population  
Usual Source of Care
% of persons who have a specific source of ongoing care4 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons in fair or poor health who have a specific source of ongoing care4 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons with a hospital, emergency room, or clinic as source of ongoing care4 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons with a community health center as source of ongoing care6 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons without a usual source of care who indicate a financial or insurance reason for not having a source of care5 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons who have a usual primary care provider5 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of adults who report very little or no choice in source of care6 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of adults who have had a regular doctor for more than five years6 Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care

1 Compared with persons with family incomes 400% of Federal poverty threshold or above.
2 Compared with persons with any college education.
3 Compared with persons under 65 with any private health insurance.
4 Source: National Center for Health Statistics, National Health Interview Survey, 2000.
5 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1999.
6 Source: The Commonwealth Fund Health Care Quality Survey, 2001.

Table 2. Socioeconomic Differences in Entry into the Health Care System (continued)

Measure Income Difference1 Educational Difference2 Insurance Difference3
<100% 100-199% 200-399% <HS HS Grad Uninsured
Patient Perceptions of Need
% of families that experience difficulties or delays in obtaining health care or do not receive needed care4 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of families that experience difficulties or delays due to financial or insurance reasons4 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of families that did not receive a doctor's care or prescription medications because the family needed the money4 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of families not very satisfied that they can get health care if they need it4 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons who can always get appointments for routine care as soon as wanted5 Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care
% of persons who can always get care for illness or injury as soon as wanted5 Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population

1 Compared with persons with family incomes 400% of Federal poverty threshold or above.
2 Compared with persons with any college education.
3 Compared with persons under 65 with any private health insurance.
4 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1999.
5 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2000.

Key to Access to Health Care Tables:

Solid black circle: Selected population and comparison population receive about same quality of health care

Circle with solid black half on top, and white half on bottom: Selected population receives better quality care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives worse quality care than the comparison population

Clear circle: Data are collected but do not meet criteria for statistical reliability

HS=high school

Table 3. Racial and Ethnic Differences in Structural Barriers within the Health Care System

Measure Racial Difference1 Ethnic Difference2
Black Asian NHOPI AI/AN >1 Race NHB Hispanic
Barriers to Getting Care
% of persons with provider who has office hours nights or weekends3 Selected population and comparison population receive about same quality of health care Selected population receives better quality care than the comparison population3 Selected population and comparison population receive about same quality of health care   Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care
% of persons with difficulty getting appointments on short notice3 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care3 Selected population receives worse quality care than the comparison population   Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care
% of persons with difficulty contacting provider over the telephone3 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care3 Selected population and comparison population receive about same quality of health care   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of adults without problems getting referral to a specialist in past year3 Selected population receives worse quality care than the comparison population Data are collected but do not meet criteria for statistical reliability4 Data are collected but do not meet criteria for statistical reliability   Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons not very satisfied with professional staff at provider's office3 Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population3 Selected population and comparison population receive about same quality of health care   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
Waiting Times
% of persons who usually wait >30 minutes before seeing provider3 Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care3 Data are collected but do not meet criteria for statistical reliability   Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of emergent/urgent emergency department visits with wait ≥ 1 hour4 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care4 Data are collected but do not meet criteria for statistical reliability      
% of semi-urgent/non-urgent emergency department visits with wait ≥ 1 hour4 Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care4 Data are collected but do not meet criteria for statistical reliability      
% of emergency department visits in which the patient left without being seen4 Selected population receives worse quality care than the comparison population Data are collected but do not meet criteria for statistical reliability4 Data are collected but do not meet criteria for statistical reliability      

1 Compared with whites.
2 Compared with non-Hispanic whites.
3 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2000. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asians or Pacific Islanders. This source did not collect information for >1 race.
4 Source: National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey-Emergency Department, 2000. This source did not collect information on Asians and NHOPIs separately. This source did not collect information for >1 race. Missing rates preclude analysis by ethnicity.

Key to Access to Health Care Tables:

Solid black circle: Selected population and comparison population receive about same quality of health care

Circle with solid black half on top, and white half on bottom: Selected population receives better quality care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives worse quality care than the comparison population

Clear circle: Data are collected but do not meet criteria for statistical reliability

NHOPI=Native Hawaiian or Other Pacific Islander; AI/AN=American Indian or Alaska Native; NHB=non-Hispanic black

Table 4. Socioeconomic Differences in Structural Barriers within the Health Care System

Measure Income Difference1 Educational Difference2 Insurance Difference3
<100% 100-199% 200-399% <HS HS Grad Uninsured
Barriers to Getting Care
% of persons with provider who has office hours nights or weekends4 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of persons with difficulty getting appointments on short notice4 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care
% of persons with difficulty contacting provider over the telephone4 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care
% of adults without problems getting referral to a specialist in past year4 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of persons not very satisfied with professional staff at provider's office4 Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care
Waiting Times
% of persons who usually wait >30 minutes before seeing provider4 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of emergent/urgent emergency department visits with wait >=1 hour5           Selected population and comparison population receive about same quality of health care
% of semi-urgent/non-urgent emergency department visits with wait >=1 hour5           Selected population receives worse quality care than the comparison population
% of emergency department visits in which the patient left without being seen5           Selected population receives worse quality care than the comparison population

1 Compared with persons with family incomes 400% of Federal poverty threshold or above.
2 Compared with persons with any college education.
3 Compared with persons under 65 with any private health insurance.
4 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2000.
5 Source: National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey-Emergency Department, 2000. This source did not collect information about income or education. Insurance contrast compares uninsured with persons with any private insurance including all ages.

Key to Access to Health Care Tables:

Solid black circle: Selected population and comparison population receive about same quality of health care

Circle with solid black half on top, and white half on bottom: Selected population receives better quality care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives worse quality care than the comparison population

Clear circle: Data are collected but do not meet criteria for statistical reliability

HS=high school

Table 5. Racial and Ethnic Differences in Ability of Provider to Address Patient Needs

Measure Racial Difference1 Ethnic Difference2
Black Asian NHOPI AI/AN >1 Race NHB Hispanic
Patient-Provider Communication
% of persons with provider who generally listens and gives needed information about health/health care3 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care3 Data are collected but do not meet criteria for statistical reliability   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of persons with provider who usually asks about medications and treatments other doctors may give3 Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care3 Selected population and comparison population receive about same quality of health care   Selected population receives better quality care than the comparison population Selected population receives better quality care than the comparison population
% of adults whose providers always listened carefully to them4 Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care4 Data are collected but do not meet criteria for statistical reliability   Selected population receives better quality care than the comparison population Selected population receives worse quality care than the comparison population
% of adults whose providers always explained things in a way they could understand4 Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care4 Data are collected but do not meet criteria for statistical reliability   Selected population receives better quality care than the comparison population Selected population receives worse quality care than the comparison population
% of adults whose providers always showed respect for what they had to say4 Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care4 Data are collected but do not meet criteria for statistical reliability   Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care
% of adults with one or more indicators of poor communication at their last visit5 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Selected population receives worse quality care than the comparison population   Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
Patient-Provider Relationship
% of persons not satisfied with quality of care received from provider3 Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population3 Selected population and comparison population receive about same quality of health care   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of persons not confident in provider's help when they have a medical problem3 Selected population and comparison population receive about same quality of health care Data are collected but do not meet criteria for statistical reliability3 Data are collected but do not meet criteria for statistical reliability   Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care
% of adults whose providers always spent enough time with them4 Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care4 Data are collected but do not meet criteria for statistical reliability   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of adults who rate their health care in the past year <6 on a scale from 0 to 104 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population4 Data are collected but do not meet criteria for statistical reliability   Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of adults not treated with a great deal of dignity and respect5 Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Selected population and comparison population receive about same quality of health care   Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care
% of adults not involved as much as wanted in decision-making5 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Selected population and comparison population receive about same quality of health care   Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of adults not with as much time as wanted with doctor5 Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of adults with incident in past two years when they did not follow doctor's advice5 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability   Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care
% of adults with family member who got sick due to doctor or hospital mistake5 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability   Selected population and comparison population receive about same quality of health care Selected population receives better quality care than the comparison population
Cultural Competency5
% of adults who believe they would have gotten better care if different race/ethnicity Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability   Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of adults who felt treated with disrespect because of race/ethnicity Selected population receives worse quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability   Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of adults who do not strongly agree that doctor understands background and values Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Selected population and comparison population receive about same quality of health care   Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care

1 Compared with whites.
2 Compared with non-Hispanic whites.
3 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1999. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asian or Pacific Islander. This source did not collect information for >1 race.
4 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2000. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asian or Pacific Islander. This source did not collect information for >1 race.
5 Source: The Commonwealth Fund Health Care Quality Survey, 2001. This source did not collect information for >1 race separately

Table 5. Racial and Ethnic Differences in Ability of Provider to Address Patient Needs (continued)

Measure Racial Difference1 Ethnic Difference2
Black Asian NHOPI AI/AN >1 Race NHB Hispanic
Health Information3
% of adults who did not find prescription bottle very easy to understand Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of adults who did not find information from doctor's office very easy to understand Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Selected population and comparison population receive about same quality of health care   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of adults who do not use web for health information Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care   Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of adults who do not use printed material for health information Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Data are collected but do not meet criteria for statistical reliability Selected population and comparison population receive about same quality of health care   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of adults who do not call their doctor for health information Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population

1Compared with whites.
2Compared with non-Hispanic whites.
3Source: The Commonwealth Fund Health Care Quality Survey, 2001. This source did not collect information for >1 race separately

Key to Access to Health Care Tables:

Solid black circle: Selected population and comparison population receive about same quality of health care

Circle with solid black half on top, and white half on bottom: Selected population receives better quality care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives worse quality care than the comparison population

Clear circle: Data are collected but do not meet criteria for statistical reliability

NHOPI=Native Hawaiian or Other Pacific Islander; AI/AN=American Indian or Alaska Native; NHB=non-Hispanic black

Table 6. Socioeconomic Differences in Ability of Provider to Address Patient Needs

Measure Income Difference4 Educational Difference5 Insurance Difference6
<100% 100-199% 200-399% <HS HS Grad Uninsured
Patient-Provider Communication
% of persons with provider who generally listens and gives needed information about health/health care7 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care
% of persons with provider who usually asks about medications and treatments other doctors may give7 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives better quality care than the comparison population
% of adults whose providers always listened carefully8 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care
% of adults whose providers always explained things in a way they could understand8 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of adults whose providers always showed respect for what they had to say8 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care
% of adults with one or more indicators of poor communication at their last visit9 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population

4 Compared with persons with family incomes 400% of Federal poverty threshold or above.
5 Compared with persons with any college education.
6 Compared with persons under 65 with any private health insurance.
7 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1999.
8 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2000.
9 Source: The Commonwealth Fund Health Care Quality Survey, 2001.

Table 6. Socioeconomic Differences in Ability of Provider to Address Patient Needs (continued)

Measure Income Difference1 Educational Difference2 Insurance Difference3
<100% 100-199% 200-399% <HS HS Grad Uninsured
Patient-Provider Relationship
% of persons not satisfied with quality of care from provider4 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care
% of persons not confident in provider's help when they have a medical problem4 Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care
% of adults whose providers always spent enough time5 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care
% of adults who rate their health care in the past year <6 on a scale from 0 to 105 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of adults not treated with a great deal of dignity and respect6 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of adults not involved as much as wanted in decisionmaking6 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of adults who did not have as much time as wanted with doctor6 Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of adults with incident in past 2 years when they did not follow doctor's advice6 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care
% of adults with family member who got sick due to doctor or hospital mistake6 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
Cultural Competency6
% of adults who believe would have gotten better care if different race/ethnicity Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of adults who felt treated with disrespect because of race/ethnicity Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of adults who do not strongly agree that doctor understands background and values Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
Health Information6
% of adults who do not find prescription bottle very easy to understand Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of adults who do not find information from doctor's office very easy to understand Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of adults who do not use web for health information Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of adults who do not use printed material for health information Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of adults who do not call doctor for health information Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population

Key to Access to Health Care Tables:

Solid black circle: Selected population and comparison population receive about same quality of health care

Circle with solid black half on top, and white half on bottom: Selected population receives better quality care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives worse quality care than the comparison population

Clear circle: Data are collected but do not meet criteria for statistical reliability

HS=high school

1 Compared with persons with family incomes 400% of Federal poverty threshold or above.
2 Compared with persons with any college education.
3 Compared with persons under 65 with any private health insurance.
4 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1999.
5 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2000.
6 Source: The Commonwealth Fund Health Care Quality Survey, 2001.

Table 7. Racial and Ethnic Differences in Health Care Utilization

Measure Racial Difference1 Ethnic Difference2
Black Asian NHOPI AI/AN >1 Race NHB Hispanic
Routine Health Care
% of persons with office or outpatient visit3 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population3 Selected population and comparison population receive about same quality of health care   Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons with prescription medications3 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population3 Selected population receives worse quality care than the comparison population   Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons with dental visit3 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population3 Selected population receives worse quality care than the comparison population   Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
Outpatient visits per population4 Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care4 Selected population receives worse quality care than the comparison population      
Acute Care
% of persons with emergency room visit3 Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population3 Selected population and comparison population receive about same quality of health care   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of persons with inpatient discharge3 Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care3 Selected population and comparison population receive about same quality of health care   Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care
Emergency department visits per population4 Selected population receives better quality care than the comparison population Selected population receives worse quality care than the comparison population4 Selected population and comparison population receive about same quality of health care      
Total hospitalizations per population5 Selected population receives better quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability      
Chronic Care
% of persons with home health visit3 Selected population and comparison population receive about same quality of health care Data are collected but do not meet criteria for statistical reliability3 Data are collected but do not meet criteria for statistical reliability   Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
Home health care discharges per population 18-646 Selected population and comparison population receive about same quality of health care6            
Home health care discharges per population 65 and older6 Selected population and comparison population receive about same quality of health care6            
Nursing home discharges per population 18-647 Selected population receives better quality care than the comparison population7            
Nursing home discharges per population 65 and older7 Selected population and comparison population receive about same quality of health care7            
Hospice discharges per population 18-646 Selected population and comparison population receive about same quality of health care6            
Hospice discharges per population 65 and older6 Selected population receives worse quality care than the comparison population6            
Avoidable Admissions8
Avoidable admissions for hypertension per population 18 and older *8 Selected population receives worse quality care than the comparison population8     Selected population receives better quality care than the comparison population Selected population receives better quality care than the comparison population
Avoidable admissions for angina per population 18 and older *8 Selected population receives worse quality care than the comparison population8     Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care
Avoidable admissions for chronic obstructive pulmonary disease per population 18 and older *8 Selected population receives worse quality care than the comparison population8     Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
Avoidable admissions for bacterial pneumonia per population *8 Selected population receives worse quality care than the comparison population8     Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care

1 Compared with whites.
2 Compared with non-Hispanic whites.
3 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1999. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asians or Pacific Islanders. This source did not collect information for >1 race.
4 Source: National Center for Health Statistics, National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey, 1999-2000. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asians or Pacific Islanders. This source did not collect information for >1 race. Missing rates preclude analysis by ethnicity.
5 Source: National Center for Health Statistics National Hospital Discharge Survey, 2000. This source did not collect information for >1 race separately. Missing rates preclude analysis by ethnicity.
6 Source: National Center for Health Statistics, National Home and Hospice Care Survey, 2000. Sample size constraints permit black-white comparisons only.
7 Source: National Center for Health Statistics, National Nursing Home Survey, 1999. Sample size constraints permit black-white comparisons only
8 Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project State Inpatient Databases, 16-State database, 2000. This source categorizes race/ethnicity very differently from other sources. Race/ethnicity information is categorized as a single item: non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander. These contrasts compare each group with non-Hispanic whites. An * is inserted in the black column to indicate that estimates for this group could not be produced.

Table 7. Racial and Ethnic Differences in Health Care Utilization (continued)

Measure Racial Difference1 Ethnic Difference2
Black Asian NHOPI AI/AN >1 Race NHB Hispanic
Mental Health Care and Substance Abuse Treatment
% of adults who received mental health treatment or counseling in the past year3 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of adults who received outpatient mental health treatment or counseling3 Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of adults who received prescription medications for mental health treatment3 Selected population receives worse quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of adults who received inpatient mental health treatment or counseling3 Selected population receives better quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care
% of adults with serious mental illness who received mental health treatment or counseling3 Selected population receives worse quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons 12 and older who received illicit drug or alcohol abuse treatment in the past year3 Selected population and comparison population receive about same quality of health care Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care
% of persons 12 and older who needed treatment for illicit drug use and who received such treatment in the past year3 Selected population receives better quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care
Inpatient admissions to specialty mental health organizations per population4 Selected population receives better quality care than the comparison population Data are collected but do not meet criteria for statistical reliability4 Data are collected but do not meet criteria for statistical reliability   Selected population receives better quality care than the comparison population Selected population receives worse quality care than the comparison population
Residential care admissions to specialty mental health organizations per population4 Selected population receives better quality care than the comparison population Data are collected but do not meet criteria for statistical reliability4 Data are collected but do not meet criteria for statistical reliability   Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care
<24 hour admissions to specialty mental health organizations per population4 Selected population receives better quality care than the comparison population Selected population receives worse quality care than the comparison population4 Selected population receives better quality care than the comparison population   Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care
HIV Care
Hospitalizations for HIV per population5 Selected population receives better quality care than the comparison population Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability Data are collected but do not meet criteria for statistical reliability      
% of HIV patients with 4+ ambulatory visits in the past year6 *6 Selected population and comparison population receive about same quality of health care6 Selected population and comparison population receive about same quality of health care   Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care
% of HIV patients with CD4 <50 with 4+ ambulatory visits in the past year6 *6 Data are collected but do not meet criteria for statistical reliability6 Data are collected but do not meet criteria for statistical reliability   Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care
% of HIV patients with inpatient hospitalization in the past year6 *6 Selected population and comparison population receive about same quality of health care6 Selected population and comparison population receive about same quality of health care   Selected population receives better quality care than the comparison population Selected population receives better quality care than the comparison population
% of HIV patients with CD4 <50 with inpatient hospitalization in the past year6 *6 Data are collected but do not meet criteria for statistical reliability6 Data are collected but do not meet criteria for statistical reliability   Selected population receives better quality care than the comparison population Selected population receives better quality care than the comparison population

Key to Health Care Utilization Tables:

Solid black circle: Selected population and comparison population receive about same amount of health care

Circle with solid black half on top, and white half on bottom: Selected population receives more care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives less care than the comparison population

Data are collected but do not meet criteria for statistical reliability: Data are collected but do not meet criteria for statistical reliability

NHOPI=Native Hawaiian or Other Pacific Islander; AI/AN=American Indian or Alaska Native; NHB=non-Hispanic black

1 Compared with whites.
2 Compared with non-Hispanic whites.
3 Source: Substance Abuse and Mental Health Services Administration, National Household Survey on Drug Abuse, 2001.
4 Source: Substance Abuse and Mental Health Services Administration, Client/Patient Survey Sample, 1997. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asians or Pacific Islanders. This source did not collect information for >1 race.
5 Source: National Center for Health Statistics, National Hospital Discharge Survey, 2000. This source did not collect information for >1 race separately. Missing rates preclude analysis by ethnicity.
6 Source: HIV Research Network, 2000. This source categorizes race/ethnicity very differently from other sources. Race/ethnicity information is categorized as a single item: non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander American Indian or Alaska Native. These contrasts compare each group with non-Hispanic whites. An * is inserted in the black column to indicate that estimates for this group could not be produced.

Table 8. Socioeconomic Differences in Health Care Utilization

Measure Income Difference1 Educational Difference2 Insurance Difference3
<100% 100-199% 200-399% <HS HS Grad Uninsured
Routine Health Care4
% of persons with office or outpatient visit Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
% of persons with prescription medications Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population receives worse quality care than the comparison population
% of persons with dental visit Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population
Acute Care4
% of persons with emergency room visit Selected population receives better quality care than the comparison population Selected population receives better quality care than the comparison population Selected population receives better quality care than the comparison population Selected population receives better quality care than the comparison population Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care
% of persons with inpatient discharge Selected population receives better quality care than the comparison population Selected population receives better quality care than the comparison population Selected population receives better quality care than the comparison population Selected population receives better quality care than the comparison population Selected population receives better quality care than the comparison population Selected population receives worse quality care than the comparison population
Chronic Care4
% of persons with home health visit Selected population receives better quality care than the comparison population Selected population receives better quality care than the comparison population Selected population and comparison population receive about same quality of health care Selected population receives better quality care than the comparison population Selected population receives better quality care than the comparison population Data are collected but do not meet criteria for statistical reliability
Mental Health Care and Substance Abuse Treatment5
% of adults who received mental health treatment or counseling in the past year       Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care  
% of adults who received outpatient mental health treatment or counseling       Selected population receives worse quality care than the comparison population Selected population receives worse quality care than the comparison population  
% of adults who received prescription medications for mental health treatment       Selected population and comparison population receive about same quality of health care Selected population and comparison population receive about same quality of health care  
% of adults who received inpatient mental health treatment or counseling       Selected population receives better quality care than the comparison population Selected population receives better quality care than the comparison population  
% of adults with serious mental illness who received mental health treatment or counseling       Selected population receives worse quality care than the comparison population Selected population and comparison population receive about same quality of health care  
% of persons age 12 and older who received illicit drug or alcohol abuse treatment in the past year       Selected population receives better quality care than the comparison population Selected population receives better quality care than the comparison population  
% of persons age 12 and older who needed treatment for illicit drug use and who received such treatment in the past year       Selected population and comparison population receive about same quality of health care Selected population receives better quality care than the comparison population  
HIV Care6
% of HIV patients with 4+ ambulatory visits in the past year           Selected population receives worse quality care than the comparison population6
% of HIV patients with CD4 <50 with 4+ ambulatory visits in the past year           Selected population receives worse quality care than the comparison population6
% of HIV patients with inpatient hospitalization in the past year           Selected population receives worse quality care than the comparison population6
% of HIV patients with CD4 <50 with inpatient hospitalization in the past year           Selected population receives worse quality care than the comparison population6

Key to Health Care Utilization Tables:

Solid black circle: Selected population and comparison population receive about same amount of health care

Circle with solid black half on top, and white half on bottom: Selected population receives more care than the comparison population

Circle with solid white half on top, and black half on bottom: Selected population receives less care than the comparison population

Clear circle: Data are collected but do not meet criteria for statistical reliability

1 Compared with persons with family incomes 400% of Federal poverty threshold or above.
2 Compared with persons with any college education.
3 Compared with persons under 65 with any private health insurance.
4 Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 1999.
5 Source: Substance Abuse and Mental Health Services Administration, National Household Survey on Drug Abuse, 2001. Income and insurance disparities were not analyzed.
6 Source: HIV Research Network, 2000. This source did not collect information about income or education. Because Ryan White covers HIV patients who otherwise would be uninsured, this insurance contrast compares HIV patients who are uninsured or have no coverage other than Ryan White with patients with private health insurance.

References

1. Guidance for the National Healthcare Disparities Report, p. 20.

2. Millman, Michal (ed.) Access to Health Care in America. Washington, DC: National Academy Press, 1993.

3. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, p. 33.

4. Trevino, F. M., Moss, A. J. Health Indicators for Hispanic, Black and White Americans. September 1984. 88pp. (PHS) 84-1576. PB87-156956. PC A05 MF A02.

5. U.S. Department of Health and Human Services. Report of the Secretary's Task Force on Black and Minority Health. Washington, D.C.: DHHS, 1985.

6. Institute of Medicine. Access to Health Care in America. Washington, D.C.: National Academy Press, 1993.

7. "Care Without Coverage: Too Little, Too Late," by the Committee on the Consequences of Uninsurance, Board on Health Care Services, Institute of Medicine. National Academy Press, Washington, DC, 2002. p. 5.

8. Sicker and Poorer: The Consequences of Being Uninsured, prepared for the Kaiser Commission on Medicaid and the Uninsured by Jack Hadley, Ph.D., The Urban Institute, in May 2002 (updated in February 2003). Executive summary can be accessed at: http://www.kff.org/uninsured/index.cfm.Exit Disclaimer

9. Hadley J; Steinberg EP; Feder J. Comparison of Uninsured and Privately Insured Hospital Patients: Conditions on Admission, Resource Use, and Outcome. JAMA 1991; 265: 374-9.

10. Centers for Disease Control. Self-Assessed Health Status and Selected Behavioral Risk Factors Among Persons With and Without Health-Care Coverage, U.S., 1994-1995. MMWR 1998; 47:176-180.

11. Franks P, Clancy CM, Gold MR, et al. Health Insurance and Subjective Health Status: Data from the 1987 National Medical Expenditure Survey. Am J Public Health 1993;83:1295-9.

12. Freeman HE; Aiken LH; Blendon RJ; Corey CR. Uninsured Working-Age Adults: Characteristics and Consequences. Health Services Res 1990; 24:811-23.

13. American Academy of Family Physicians, Center for Policy Studies in Family Practice and Primary Care, February 2000. Was cited by the Ohio Academy of Family Physicians on their web site..

14. "The Importance of Having a Usual Source of Care," One Pager Number 3, January 2000; The Robert Graham Center for Policy Studies in Family Practice and Primary Care.

15. The importance of having a usual source of health care; American Family Physician; Kansas City; Aug 1, 2000.

16. Lou Ann Hartley, "Examination of primary care characteristics in a community-based clinic Journal of Nursing Scholarship"; Indianapolis; Fourth Quarter 2002; Volume 34, Issue 4, pp. 377.

17. IOM. Coverage Matters: Insurance and Health Care, Washington, DC: National Academies Press, 2001.

18. Institute of Medicine. (1996). Primary care: American's health in a new era. Washington, DC: National Academy Press.

19. U.S. Department of Health and Human Services. "Healthy People 2010: Understanding and Improving Health." Conference Edition, Volume 1. Washington, DC: January 2000, p. 45.

20. Millman, Michal (ed.) Access to Health Care in America. Washington, DC: National Academy Press, 1993.

21. Grumbach K, Selby JV, Damberg C, Bindman AB, Quesenberry C Jr, Truman A, Uratsu C. Resolving the gatekeeper conundrum: what patients value in primary care and referrals to specialists. JAMA. 1999;282(3):261-6.

22. Grumbach K, Osmond D, Vranizan K, Jaffe D, Bindman AB. Primary care physicians' experience of financial incentives in managed-care systems. N Engl J Med 1998; 339(21):1516-21.

23. Healthy People 2010, p. 11-3.

24. Healthy People 2010, p. 11-8; also, Roter, D.L., and Hall, J.A. Doctors Talking with Patients/Patients Talking with Doctors: Improving Communication in Medical Visits. Westport, CT: Auburn House, 1992.

25.Collins, Karen Scott, Hughes, Dora L., Doty, Michelle M., Ives, Brett L., Edwards, Jennifer N., Tenney, Katie. "Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans." The Commonwealth Fund, New York: March 2002, p. 9.

26. Review of Emanuel, E.J., and Emanuel, L.L. "Four Models of the Physician-Patient Relationship." JAMA 267, no. 16 (1992): 2221-2226.

27. "Conflicting values and the patient-provider relationship in managed care"; Tamara T Stone; Journal of Health Care Finance, New York; Fall 1999; Vol. 26, Iss. 1; pg. 48, 15 pgs.

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30. Joseph R. Betancourt, Alexander R. Green, and J. Emilio Carrillo. Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches. Field Report for the Commonwealth Fund, October 2002. http://www.commonwealthfund.org/usr_doc/betancourt_culturalcompetence_576.pdf?section=4039.Exit Disclaimer Accessed August 17, 2007.

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32. Betencourt, et al, 2002; refer also to Cindy Brach and Irene Fraser. "Reducing disparities through culturally competent health care: An analysis of the business case." Quality Management in Health Care 10(4), pp. 15-28, 2002; and Elena Cohen and Tawara D. Goode, "National Center for Cultural Competence," Policy Brief 1, Rationale for Cultural Competence in Primary Health Care. Winter 1999. http://www11.georgetown.edu/research/gucchd/nccc/documents/Policy_Brief_1_2003.pdf [PDF Help].Exit Disclaimer Accessed 8/17/2007.

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36. Healthy People 2010, p. 11-9; also, Baker, D.W.; Parker, R.M.; Williams, M.V.; et al. "The relationship of patient reading ability to self-reported health and use of health services." American Journal of Public Health 87:1027-1030, 1997.

37. Williams, M.V., Baker, D.W., Parker, R.M., et al. "Relationship of functional health literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes." Archives of Internal Medicine 158:166-172, 1998.

38. Williams, M.V., Baker, D.W., Honig, E.G., et al. "Inadequate literacy is a barrier to asthma knowledge and self-care." Chest 114:1008-1015, 1998.

39. Williams, M.V., Parker, R.M., Baker, D.W., et al. "Inadequate functional health literacy among patients at two public hospitals." JAMA 281:1677-1682, 1995.

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