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National Healthcare Disparities Report, 2005

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Facilitators and Barriers to Health Care

Facilitators and barriers to health care discussed in this section include health insurance, having a usual source of care (including having a usual source of ongoing care and a usual primary care provider), and patient perceptions of need. (Go to Tables 3.1a and 3.1b for a summary of findings related to all core report measures on facilitators and barriers to health care.)

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Health Insurance

Health insurance facilitates entry into the health care system. The uninsured are more likely to die early3,4,5 and have poor health status6,7; the costs of early death and poor health among the uninsured total $65 billion to $130 billion.3,8 The financial burden of uninsurance is also great for uninsured individuals; almost 50% of personal bankruptcy filings are due to medical expenses.9 The uninsured report more problems getting care,9,10 are diagnosed at later disease stages, and get less therapeutic care.9,11 They are sicker when hospitalized and more likely to die during their stay.11

Figure 3.1. Persons under age 65 with health insurance, by race (top), ethnicity (upper middle), income (lower middle), and education (bottom), 1999-2003

Figure 3.1. Persons under age 65 with health insurance, by race (top), ethnicity (middle), income (bottom), and education (bottom), 1999-2003

[D] Select for Full Text Description.

Figure 3.1. Persons under age 65 with health insurance, by race (top), ethnicity (middle), income (bottom), and education (bottom), 1999-2003

[D] Select for Full Text Description.

Figure 3.1. Persons under age 65 with health insurance, by race (top), ethnicity (middle), income (bottom), and education (bottom), 1999-2003

[D] Select for Full Text Description.

Figure 3.1. Persons under age 65 with health insurance, by race (top), ethnicity (middle), income (bottom), and education (bottom), 1999-2003

[D] Select for Full Text Description.

Key: AI/AN = American Indian or Alaska Native; NHOPI = Native Hawaiian or Other Pacific Islander.

Source: National Health Interview Survey, 1999-2003.

Reference population: Civilian noninstitutionalized persons under age 65.

Note: Measure is age adjusted. NHIS respondents are asked about health insurance coverage at the time of interview; respondents are considered uninsured if they lack private health insurance, public assistance, Medicare, Medicaid, a State-sponsored health plan, other government sponsored programs, a military health plan, or if their only coverage is through the Indian Health Service.

  • In all 5 years, the proportion of persons with insurance was lower among Blacks and AI/ANs compared with Whites; among Hispanics compared with non-Hispanic Whites; among poor, near poor, and middle income persons compared with high income persons; and among persons with a high school education or less compared with persons with some college (Figure 3.1).
  • From 2000 to 2002 the proportion of persons with insurance was also lower among persons of multiple races compared with Whites; in 2000 the proportion was lower among NHOPIs compared with Whites. In 2003, both disparities had been eliminated.
  • From 1999 to 2003, rates of insurance decreased for Whites, middle and high income persons, and persons of every education level, while rates increased for the poor.

Racial and ethnic minorities are disproportionately of lower socioeconomic status. To distinguish the effects of race, ethnicity, income, and education on health insurance coverage, this measure is stratified by income and education level.

Figure 3.2. Persons under age 65 with health insurance by race (top) and ethnicity (bottom) stratified by income, 2003

Figure 3.2. Persons under age 65 with health insurance by race (top) and ethnicity (bottom) stratified by income, 2003

[D] Select for Full Text Description.

Figure 3.2. Persons under age 65 with health insurance by race (top) and ethnicity (bottom) stratified by income, 2003

[D] Select for Full Text Description.

Key: AI/AN = American Indian or Alaska Native.

Source: National Health Interview Survey, 2003.

Reference population: Civilian noninstitutionalized persons under age 65.

Note: Measure is age adjusted.NHIS respondents are asked about health insurance coverage at the time of interview; respondents are considered uninsured if they lack private health insurance, public assistance, Medicare, Medicaid, a State-sponsored health plan, other government sponsored programs, a military health plan, or if their only coverage is through the Indian Health Service.

Figure 3.3. Persons under age 65 with health insurance by race (top) and ethnicity (bottom) stratified by education, 2003

Figure 3.3. Persons under age 65 with health insurance by race (top) and ethnicity (bottom) stratified by education, 2003

[D] Select for Full Text Description.

Figure 3.3. Persons under age 65 with health insurance by race (top) and ethnicity (bottom) stratified by education, 2003

[D] Select for Full Text Description.

Key: AI/AN = American Indian or Alaska Native.

Source: National Health Interview Survey, 2003.

Reference population: Civilian noninstitutionalized persons under age 65.

Note: Measure is age adjusted.NHIS respondents are asked about health insurance coverage at the time of interview; respondents are considered uninsured if they lack private health insurance, public assistance, Medicare, Medicaid, a State-sponsored health plan, other government sponsored programs, a military health plan, or if their only coverage is through the Indian Health Service.

  • Socioeconomic status explains some but not all of the differences in rates of insurance among persons under age 65 by race and ethnicity (Figures 3.2 and 3.3).
  • Hispanics of every income and education level were less likely than respective non-Hispanic Whites to have health insurance.
  • AI/AN-White differences were significant among all income groups other than the poor and among all education groups other than persons with less than a high school education. High income Blacks and Blacks with a high school education or any college education were less likely than respective Whites to have health insurance; near poor Blacks and Blacks with less than a high school education were more likely than respective Whites to have insurance.
  • No group achieved the Healthy People 2010 goal of 100% of Americans with health insurance.

Because uninsured persons often postpone seeking care, have difficulty obtaining care when they ultimately seek it, and must bear the full brunt of health care costs, prolonged periods of uninsurance can have a particularly serious impact on a person's health and stability. Over time, the cumulative consequences of being uninsured compound, resulting in a population at particular risk for suboptimal health care and health status.

Figure 3.4. Persons under age 65 uninsured all year by race (top), ethnicity (upper middle), income (lower middle), and education (bottom), 1999-2002

Figure 3.4. Persons under age 65 uninsured all year by race (top), ethnicity (middle), income (bottom), and education (bottom), 1999-2002

[D] Select for Full Text Description.

Figure 3.4. Persons under age 65 uninsured all year by race (top), ethnicity (middle), income (bottom), and education (bottom), 1999-2002

[D] Select for Full Text Description.

Figure 3.4. Persons under age 65 uninsured all year by race (top), ethnicity (middle), income (bottom), and education (bottom), 1999-2002

[D] Select for Full Text Description.

Figure 3.4. Persons under age 65 uninsured all year by race (top), ethnicity (middle), income (bottom), and education (bottom), 1999-2002

[D] Select for Full Text Description.

Source: Medical Expenditure Panel Survey, 1999-2002.

Reference population: Civilian noninstitutionalized persons under age 65.

Note: In 2002, survey respondents could report more than one race. Racial categories shown here for 2002 exclude multiple race individuals and hence are not directly comparable to earlier years. Estimates for racial groups other than Whites and Blacks are significantly affected by this change and are not shown here.

  • In all 4 years, the proportion of persons uninsured all year was higher among Hispanics compared with non-Hispanic Whites; among poor, near poor, and middle income persons compared with high income persons; and among persons with a high school education or less compared with persons with some college (Figure 3.4).
  • The proportion of persons uninsured all year was higher among Blacks compared with Whites in 1999 and 2000. In 2001 and 2002, this disparity was eliminated.
  • From 1999 to 2002, rates of uninsurance rose among Whites, non-Hispanic Whites, middle income persons, and high school graduates.

 

 

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