Minorities Continue to Face Health Care Obstacles, Study Finds
particularly Hispanics and Asian-Americans, are more likely than non-Hispanic whites to
report obstacles in access to health care, according to a UCSF study.
The study, which appears in the July/August issue of the journal Health Affairs,
compared access across racial/ethnic groups and documented cultural barriers. The
researchers are also among the first to examine the effects of managed care on minority
populations and compare access across insurance plans.
Analyzing data from the 1996 Medical Expenditure Panel Survey that included responses
from more than 22,000 individuals and 9,000 families from around the country, the
researchers discovered that Hispanics more frequently reported difficulty getting care,
said Kathryn Phillips, lead author of the new study and UCSF associate professor of health
economics and health services research in the School of Pharmacy and Philip R. Lee Institute for Health Policy Studies.
Also, they more frequently reported going without needed care and lacking the assurance
that family members could get necessary care. Nearly one-third of Hispanics in the study
reported a lack of usual source of care (either a clinic or physician). In addition, they
were twice as likely to report long waits for care and that their provider failed to
listen to them and provide them with needed information.
Asian-Americans in the study were most likely to report dissatisfaction with the
quality of care provided by their primary care physician. They also reported with more
frequency that they would not go to their primary care provider for new health problems,
preventive health care, or referral. Contrary to popular perceptions, this suggests that
Asian Americans may experience less continuity of care than other racial/ethnic groups,
Reasons for the increased obstacles to care among Asian Americans remain unclear, she
added. Though Asian-American and non-Hispanic white families often share similar
sociodemographic profiles, previous studies have found that Asian Americans are more
likely to have lapses in health coverage and to report high levels of family and community
African-Americans reported similar barriers to care when compared to non-Hispanic
whites, but with less frequency than Hispanics or Asian-Americans. Non-Hispanic whites
reported the poorest access to care on only one measure, said the researchers: whether the
provider asks about medications and treatments prescribed by other doctors.
"These findings reinforce the fact that language, cultural, and economic
differences are barriers to health care," said Phillips, who added that minorities
also have a more limited choice of insurance plans than whites.
The UCSF researchers also examined the effects of managed care on access to health care
and compared access across insurance plans. Non-managed care enrollees were defined as
those not enrolled in an HMO that requires them to obtain care from specified HMO
providers or clinics.
Managed care enrollees (across all ethnic/racial groups) do not necessarily face more
barriers to health care than non-managed care enrollees - just different ones, said
Phillips. In fact, managed care enrollees experience few financial barriers to care and
report better continuity of care than non-managed care enrollees, she said. However, they
had more difficulty getting appointments and contacting their providers by phone and
expressed less satisfaction with their care than their non-managed care counterparts.
These trends were similar when researchers compared managed care to non-managed care
enrollees within racial/ethnic groups.
Phillips emphasized that expansion of insurance coverage will not ease many of the
access obstacles that both managed care and non-managed care enrollees face. Although
being uninsured is linked to worse access, the majority of families in this national
sample had insurance, she emphasized. "This highlights the importance of other
factors in determining access to care," she said. "Most people reporting
hardship in accessing care are not poor. Clearly, these access issues cut across
racial/ethnic and socioeconomic groups."