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National Healthcare Disparities Report, 2004

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Getting Care Within the Health Care System

Difficulty Getting Care

Gaining entry into the health care system does not ensure that patients receive all the services that they need; many patients report difficulties navigating the health care system even after they have gained entry. For example, a quarter of managed care patients report difficulties obtaining referrals to specialists15. Difficulty scheduling appointments or reaching the physician via phone, long waiting times for an appointment, and dissatisfaction with physician staff can lead patients16 and parents of patients17 to seek non-urgent emergency department (ED) visits. Problems getting care within the health care system can include provider unavailability on nights or weekends; dissatisfaction with professional staff; longer waiting times; and difficulties getting appointments, contacting providers by phone, and getting referrals to specialists.

Figure 3.5. Adults without problems getting referral to a specialist in the past year by race, ethnicity, and income, 2000-2001

Figure 3.5. Adults without problems getting referral to a specialist in the past year by race, ethnicity, and income, 2000-2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: Medical Expenditure Panel Survey, 2000-2001.

Reference population: Civilian, noninstitutionalized people age 18 and over.

Note: For findings related to all measures of getting care within the health care system, go to Tables 3.2a and 3.2b.

  • From 2000 to 2001, rates of no problems getting a referral decreased among Hispanics but did not change among any other groups (Figure 3.5).
  • In 2000 and 2001, the proportion of adults without problems getting a referral to a specialist was lower among Hispanic compared with non-Hispanic white adults and poor and near poor compared with high income adults.
  • The proportion of adults without problems getting a referral was also lower among API compared with white adults in 2001 (there were too few APIs to provide a reliable estimate in 2000); black-white differences were not noted.
  • In multivariate models controlling for age, gender, income, education, insurance, and residence location, racial, ethnic, and income-related differences persist. APIs are 63% less likely than whites and Hispanics are 47% less likely than non-Hispanic whites to report no problems getting referrals. Compared with high income adults, the poor and near poor are 41% and 28% less likely to report no problems getting referrals, respectively.

To distinguish the effects of race, ethnicity, and income on health care access and to identify populations at greatest risk for difficulties getting care within the health care system, measures are presented by income level.

Figure 3.6. Adults without problems getting referral to a specialist in the past year by race (top) and ethnicity (bottom) stratified by income, 2001

Figure 3.6. Adults without problems getting referral to a specialist in the past year by race stratified by income, 2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Figure 3.6. Adults without problems getting referral to a specialist in the past year by ethnicity stratified by income, 2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: Medical Expenditure Panel Survey, 2001.

Reference population: Civilian, noninstitutionalized people age 18 and over.

  • Income explains some but not all of the differences in rates of problems getting a referral to a specialist among adults by ethnicity.
  • Ethnic differences are observed across all income groups (Figure 3.6).

 

 

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