The Impact of
But while insurance and more active community clinics might
help provide continuity of care, Kathryn Phillips has discovered that it may not solve
some of the other barriers to good health. In her recent work, Phillips and her colleagues
have found that such things as long wait times for an appointment or unresponsive
providers can decrease the quality of medical care, particularly for Hispanics and
In a study published in the July/August 2000 Health Affairs, Phillips and her
colleagues describe barriers to care reported by racial and ethnic groups -- and explore
the extent to which these barriers vary between those enrolled in managed care versus
non-managed care plans. The study found that while most insured people express
satisfaction with their care, a substantial percentage report barriers. Minorities were
more likely than non-Hispanic whites to report these problems, regardless of the type of
insurance, with Hispanics and Asian-Americans reporting these problems in the biggest
numbers. "Race and ethnicity," says Phillips, "are among the key individual
predictors of access barriers."
Phillips believes the study can be used in a number of significant ways, beyond
pointing the way to more research. Most notably, she believes that we might begin using
access barriers as legitimate measures of the quality of care. She also believes that
access barriers might be used to measure how proposed and current policy changes
differentially affect racial and ethnic groups.
Socioeconomic Status Affects All
As befits the international reputation of UCSF, the CHC's work extends across the
nation and around the world. CHC director Nancy Adler, for example, heads The MacArthur
Foundation Research Network on Socioeconomic Status and Health. This international group
of scientists has already established that the influence of socioeconomic status goes
beyond the poor or uneducated, and affects everyone, regardless of their position in the
Now, these scientists are tracing the paths by which socioeconomic factors influence
health. Stress exposure is one clear path. Adler and her colleagues have shown that the
lower people are on the socioeconomic hierarchy, the more that constant adaptations to
stress inflict wear-and-tear on the body. The more stress-related wear-and-tear, the much
higher the risk for disease and early death.
But Adler's group has also found that psychological factors may mediate this process.
That is, how individuals perceive their social standing is equally or more strongly
related to their physical and mental health than objective factors, such as education,
income, or occupation. A recent volume of Annals of the New York Academy of Sciences,
co-edited by Adler, examines in considerable detail the relationship between socioeconomic
status and health in industrial nations.