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Racial/Ethnic Disparities

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Factors beyond insurance coverage affect racial/ethnic disparities in health care

Despite marked improvements in overall national health, racial and ethnic minorities continue to have poorer access to high-quality health care services and different patterns of use compared with whites. Since whites are more likely than any other group to have insurance coverage, recent health policy reforms have focused on expanding health insurance coverage to reduce these disparities. However, insurance coverage alone will not eliminate disparities because other factors also play a role, conclude Samuel H. Zuvekas, Ph.D, and Gregg S. Taliaferro, Ph.D., of the Center for Cost and Financing Studies, Agency for Healthcare Research and Quality.

Drs. Zuvekas and Taliaferro used data from the 1996-1999 Medical Expenditure Panel Survey (MEPS), county-level health care system data, and data from other sources to examine the roles that insurance coverage, the health care delivery system, and external factors play in explaining racial/ethnic disparities in access to outpatient care among patients of all ages. About 5 percent more blacks than whites and 15 percent more Hispanics than whites lacked a usual source of care throughout the 1996-1999 period. Blacks and Hispanics were much less likely than whites to use non-ER outpatient treatment, and they made fewer visits than whites did. This finding was particularly pronounced among children younger than age 18, for whom variation in health care needs is less.

Health insurance explained 42 percent of the black-white disparity in having a usual source of care but only 24 percent of the Hispanic-white disparity in this measure and even smaller proportions of the disparities in outpatient visits. Measures of variation in health care system capacity, such as number of physicians or beds per capita, explained almost none of the differences between groups.

Other factors explained 53 percent of the black-white disparity in having a usual source of care, with local area demographic and economic indicators (28 percent), income (17 percent), and demographic characteristics (16 percent) being the most important factors, while education explained little. In contrast, education explained about 20 percent of the Hispanic-white and 10 percent of the black-white gaps in use of outpatient care, while income explained little.

More details are in "Pathways to access: Health insurance, the health care delivery system, and racial/ethnic disparities, 1996-1999," by Drs. Zuvekas and Taliaferro, in the March 2003 Health Affairs 22(2), pp. 139-153.

Reprints (AHRQ Publication No. 03-R028) are available from the AHRQ Publications Clearinghouse.

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