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Minority children receive fewer medications
Compared with white children, black and Hispanic children are
less likely to receive a prescribed medication for a specific
condition and to receive fewer overall prescribed medications,
even after accounting for other factors that affect the use of
prescription medicines, such as health condition, number of
physician visits, and socioeconomic status, according to Beth A.
Hahn, Ph.D., a former research fellow with the Agency for Health
Care Policy and Research. Drug therapy is required for many acute
conditions in small children, and an estimated 40 percent of
children's office visits are due to infectious diseases that
require antibiotics or other prescription drugs.
Medicaid programs may need to specifically target the medication
needs of minority children, suggests Dr. Hahn, who used data from
the 1987 National Medical Expenditure Survey to examine the
probability of receiving a prescription medication for children
ages 1 to 5 years and 6 to 17 years. She found that among older
children, just over half of minority children received a
prescription medication compared with two-thirds of white
children. And older white children received a higher average
number of medications than either black or Hispanic children.
About 75 percent of younger white and Hispanic children received
a prescription medication for a given condition compared with 63
percent of black children. There was no difference in the average
number of medications prescribed for young Hispanic children
compared with whites, but young black children on average
received one less medication. Dr. Hahn's findings confirm those
of other researchers who have demonstrated racial and ethnic
differences in the receipt of health services and confirm that
minority children receive fewer services than white children.
More details are in "Children's health: Racial and ethnic
differences in the use of prescription medications," by Dr. Hahn,
in the May 1995 issue of Pediatrics 95(5), pp. 727-732.
Racial variations found in use of community
elderly rural residents
Although 85 percent of elderly North Carolinians are aware of
community services such as home-delivered meals and senior
centers, few use them. The most widely used services are senior
centers (13 percent) and places that serve group meals (9
percent). Elderly blacks use both types of services to a larger
extent than more economically advantaged whites, who may view
these services as a "handout" and the centers as the domain of
black people, explains Jim Mitchell, Ph.D., of East Carolina
University, author of a study supported by the Agency for Health
Care Policy and Research (HS05381).
Based on data from a 1990-1991 study of health care use among 868
noninstitutionalized elderly people in eastern North Carolina,
Dr. Mitchell assessed the effects of demographics, need, and
access to services on use of services such as help with chores,
supplemental security income, home repair, meals on wheels, and
home health care. Results showed that use of these services was
most influenced by need (measured by chronic health conditions,
number of prescription medications, and functional independence),
regardless of access barriers such as illiteracy and lack of
Race was the only demographic variable that had a significant
effect on senior center use. Elderly blacks with physical
limitations and few social contacts, who had more help from
others and were aware of the centers, were the most likely to use
them. This suggests that senior centers are moving toward meeting
the needs of elderly persons with limited capabilities rather
than toward commonly perceived recreational or personal
enrichment services, concludes Dr. Mitchell.
For more information, see "Service awareness and use among older
North Carolinians," by Dr. Mitchell, in the June 1995 issue of
The Journal of Applied Gerontology 14(2), pp. 193-209.
Rural Nebraskans have at least as much access
care as their urban counterparts
Generally, access to health care is more limited in rural than
urban America, according to several national surveys. Rural
residents are more apt to be distant from doctors and hospitals,
have limited public transportation, low income, and no health
insurance compared with urban residents. Yet a new study shows
that access to health care, even in isolated parts of rural
Nebraska, was as good, if not better, than access to health care
in urban parts of the State during the late 1980s. The fact that
Nebraska's experience differs from the Nation as a whole argues
for State involvement in developing any new networks for
delivering health care services, note authors John Comer, Ph.D.,
and Keith Mueller, Ph.D., of the University of Nebraska Medical
With support from the Agency for Health Care Policy and Research
(HS05760), the researchers used a random sample of nearly 6,000
households to compare residents of urban and rural Nebraskan
counties on several measures of access to health care. After
controlling for health insurance status, they found that rural
residents were more apt to have a personal physician and visit
the physician more often than their urban counterparts. Even
uninsured rural residents reported an average of two more visits
than urban residents during the study year (1989-1990), even
after accounting for need for health care (severity of illness).
Also, a larger percentage of rural residents with health problems
were hospitalized than urban residents, but this was a small and
statistically insignificant difference.
Rural Nebraskans were no more likely to cite inability to pay as
a deterrent to seeking care than urban Nebraskans. Nebraskan
rural health care costs are cheaper than similar urban costs.
Since the rural health care dollar goes a bit further, rural
hospitals and physicians may be more willing to carry patients
who cannot pay and who do not have insurance. This is not the
kind of pattern one would expect if access were more of a problem
in rural areas, conclude the researchers.
Details are in "Access to health care: Urban-rural comparisons
from a midwestern agricultural state," by Dr. Comer and Dr.
Mueller, in The Journal of Rural Health 11(2), pp.
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