The contribution of insurance coverage and community resources to reducing racial/ethnic disparities in access to care - Impact of Health Care Context

Health Services Research, June, 2003 by J. Lee Hargraves, Jack Hadley

Table 4 shows the decomposition of differences in access to care between African Americans and whites. For all three measures, differences in population characteristics explained less of the black--white differences than the Hispanic--white differences. Unexplained differences accounted for approximately one-half of the black--white differences in having a regular health care provider and one-quarter of the differences in having a doctor visit. Insurance coverage was the primary population characteristic that explained differences between African Americans and whites in having a regular health provider and a doctor visit last year.

The total difference between African Americans and whites in terms of reporting unmet medical needs was 1.14, where--0.65 was due to coefficients and 1.79 was due to means. If blacks had whites' characteristics, their unmet needs would be about 56 percent (1/1.79) smaller than they actually reported. However, because of the differences in coefficients, which indicate that a given factor has less impact in reducing unmet needs for blacks than for whites, the net result was that their unmet needs were 14 percent greater.

Community characteristics of African Americans and whites accounted for a small amount of the differences in having a regular provider and seeing a doctor in the past year. Availability of emergency rooms and physicians providing charity care was much less of a factor in explaining differences than that of income and insurance coverage.

DISCUSSION

This study examines differences between either African Americans or Hispanics and whites in access to care for three broad access measures: unmet medical needs, having a regular health care provider, and having seen a physician in the last year. Differences in measured characteristics explain between 81 and 97 percent of the observed differences in access to care between Hispanics and whites. Difference in characteristics explains between 47 and 97 percent of the observed differences in access to care between African Americans and whites.

Lack of health insurance is a significant access barrier, especially for Hispanics. It is the single most important factor in white--Hispanic differences for all three measures and for two of the white--African American differences (Table 5).

Income differences are the second most important factor, with one exception--reporting of unmet medical needs among African Americans. Following insurance and income, community characteristics generally were much less important, again with one exception. Safety net resources accounted for a modest proportion of the differences between Hispanics and whites in their reports of unmet medical needs. Hispanics tend to live in areas with less physician charity care and fewer emergency rooms. These two community measures of the safety net likely contribute to Hispanics reporting unmet medical needs.

Insurance coverage appears more important than supply of medical resources in minority groups' communities, including primary care physicians, charity care, and availability of hospital emergency rooms. Clearly, insurance provides links to the health care system for all, and insurance coverage would have a positive effect on Hispanics' access to care. If Hispanics were able to obtain the same levels of insurance coverage as whites, a significant portion of the disparities in access to care would be reduced.