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National Healthcare Disparities Report, 2004

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Getting Into the Health Care System

Health Insurance

Health insurance helps people get into the health care system. In 2002, 15.2% of Americans were uninsured3. The uninsured are more likely to die early4,5 and have poor health status6,7; the costs of early death and poor health among the uninsured total $65 billion to $130 billion8. The uninsured report more problems getting care9, are diagnosed at later disease stages, and get less therapeutic care10. They are sicker when hospitalized and more likely to die during their stay11.

Figure 3.1. People under age 65 with health insurance by race (top), ethnicity (middle), and income (bottom), 1999-2001

Figure 3.1. People under age 65 with health insurance by race, 1999-2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Figure 3.1. People under age 65 with health insurance by ethnicity, 1999-2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Figure 3.1. People under age 65 with health insurance by income, 1999-2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: National Heath Interview Survey, 1999-2001.

Reference population: Civilian, noninstitutionalized people under age 65.

Note: Measure is age adjusted. NHIS respondents are asked about health insurance coverage at the time of interview (point-in-time estimate). For findings related to all health insurance measures, go to Tables 3.1a and 3.1b.

  • For all years, the proportion with insurance was lower among blacks and AI/ANs compared with whites; Hispanics compared with non-Hispanic whites; and poor, near poor, and middle income compared with high income groups (Figure 3.1).
  • From 1999-2001, rates of insurance did not change significantly among any racial, ethnic, or income groups.

Racial and ethnic minorities are disproportionately poor. To distinguish the effects of race, ethnicity, and income on health care access, measures are presented by income level.

Figure 3.2. People under age 65 with health insurance by race (top) and ethnicity (bottom) stratified by income, 2001

Figure 3.2. People under age 65 with health insurance by race stratified by income, 2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Figure 3.2. People under age 65 with health insurance by ethnicity stratified by income, 2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: National Heath Interview Survey, 2001.

Reference population: Civilian, noninstitutionalized people under age 65.

Note: Measure is age adjusted. NHIS respondents are asked about health insurance coverage at the time of interview (point-in-time estimate).

  • Income explains some but not all of the differences in rates of insurance among people under age 65 by race and ethnicity.
  • While differences in health insurance tend to attenuate or disappear among blacks and among high income individuals, they persist among poor and near poor AI/ANs and Hispanics (Figure 3.2).
  • No group achieved the HP2010 goal of 100% of Americans with health insurance.

Usual Source of Care

Having a usual source of care helps people get into the health care system, yet over 40 million Americans do not have a specific source of ongoing care12. People without a usual source of care report more difficulties obtaining needed services13 and fewer preventive services, including blood pressure monitoring, flu shots, prostate exams, Pap tests, and mammograms14.

Figure 3.3. People with a specific source of ongoing care by race (top), ethnicity (middle), and income (bottom), 1999-2001

Figure 3.3. People with a specific source of ongoing care by race, 1999-2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Figure 3.3. People with a specific source of ongoing care by ethnicity, 1999-2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Figure 3.3. People with a specific source of ongoing care by income, 1999-2001. Select Full Text Description [D] for details.

[D] Select for Full Text Description.

Source: National Heath Interview Survey, 1999-2001.

Reference population: Civilian, noninstitutionalized population.

Note: Measure is age adjusted. For findings related to all usual source of care measures, go to Tables 3.1a and 3.1b.

  • In all 3 years, the proportion of people with a specific source of ongoing care was lower among Hispanics compared with non-Hispanic whites and among poor, near poor, and middle income groups compared with high income groups; racial differences were not significant (Figure 3.3).
  • Between 1999 and 2001, rates of source of ongoing care improved for all groups except AI/AN, multiple race individuals, Hispanics, and the poor.
  • No group achieved the HP2010 goal of 96% of Americans with a specific source of ongoing care.

Patient Perceptions of Need

Patient perceptions of need include perceived difficulties or delays obtaining care and problems getting care as soon as it is wanted. While patients may not always be able to assess their need for care, problems getting care when patients perceive that they are ill or injured likely reflect significant barriers to care.

Figure 3.4. Adults who can sometimes or never get care for illness or injury as soon as wanted by race, ethnicity, and income, 2000-2001

Figure 3.4. Adults who can sometimes or never get care for illness or injury as soon as wanted 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 patient perceptions of need measures, go to Tables 3.1a and 3.1b.

  • In both 2000 and 2001, the proportion of adults who sometimes or never get care for illness or injury as soon as they wanted was higher among Hispanic compared with non-Hispanic white adults and among poor and near poor compared with high income adults (Figure 3.4).
  • The proportion of adults who sometimes or never get care for illness or injury as soon as they wanted was also higher among black and API adults compared with white adults in 2001 (there were too few APIs to provide a reliable estimate in 2000).
  • From 2000 to 2001, the proportion of adults who sometimes or never get care for illness or injury as soon as they wanted decreased among white, non-Hispanic white, and high income adults.
  • In multivariate models controlling for age, gender, income, education, insurance, and residence location, the black-white difference is attenuated, but other differences persist in 2001. APIs are 99% more likely than whites, Hispanics are 45% more likely than non-Hispanic whites, and the near poor are 47% more likely than high income people to have problems getting care for illness or injury.
Getting Care Within the Health Care System 3. Access to Health Care

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