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Racial/ethnic disparities in health care access and use are not explained by health insurance and income

The existence of racial and ethnic disparities in health care has been well documented. Such disparities have been found across a broad range of health conditions and also in health insurance status, access to care, and use of health care services. Having a usual source of care is one marker used to measure access to care. According to a recent study, Hispanic Americans have become increasingly more likely to lack a usual source of care over the past 20 years, while black and white Americans saw few changes. Also, even though all racial and ethnic groups studied increased their number of outpatient visits during this time, there were increasing disparities in the number of these visits for both blacks and Hispanics.

The study addressed one popular myth regarding racial and ethnic differences in health care: that disparities among black, Hispanic, and white Americans can be explained wholly or in large part by disparities in income and health insurance coverage among these groups. One-half to three-fourths of the disparities observed in 1996 would have remained even if racial and ethnic differences in income and health insurance coverage were eliminated, according to Robin M. Weinick, Ph.D., Samuel H. Zuvekas, Ph.D., and Joel W. Cohen, Ph.D., of the Agency for Healthcare Research and Quality.

The researchers analyzed data from a series of three nationally representative medical expenditure surveys (1977 National Medical Care Expenditure Survey, 1987 National Medical Expenditure Survey, and the 1996 Medical Expenditure Panel Survey) to explore racial and ethnic differences in access to and use of health care services from 1977 to 1996.

Overall, there was little change in the proportion of Americans who had no usual source of care, with only a slight increase from 15.2 percent in 1977 to 17.4 percent in 1996. However, after adjustment for health insurance, income, and other individual characteristics, blacks were 2.1 percentage points and Hispanics were nearly 10 percentage points more likely to lack a usual source of care than whites in 1996. Between 1977 and 1996, this disparity for blacks had declined by 3.2 percentage points, but the disparity for Hispanics had increased by 6.5 percentage points.

During this same period, the probability of using any outpatient care increased slightly for all Americans. There was no significant change in the disparity in use of outpatient care by blacks compared with whites from 1977 to 1996. However, for Hispanic Americans, there were considerable changes over the same time period. The disparity between Hispanics and whites in use of outpatient care increased even after adjustments were made for health insurance and income. Most of the change occurred between 1977 and 1987, with the disparity at the end of the 20-year period measuring 8.8 percentage points.

For more information, see "Racial and ethnic differences in access to and use of health care services, 1977 to 1996," by Drs. Weinick, Zuvekas, and Cohen, in the November 2000 Medical Care Research and Review 57 (Suppl. 1), pp. 36-54.

Reprints (AHRQ Publication No. 01-R006) are available from the AHRQ Publications Clearinghouse.

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