July 28, 2000
Minorities, particularly Hispanics and Asian Americans, are more likely than non-Hispanic whites to report obstacles in access to health care, according to a University of California, San Francisco study. The study, which appears in the July/August issue of the journal Health Affairs (a leading health policy journal), 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 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, explained Phillips.
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 stress.
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."
Co-investigators on this study included, Michelle L. Mayer, PhD, RN, MPH, clinical research associate with the Children's Health Initiative at Lucile S. Packard Children's Hospital at Stanford and Lu Ann Aday, PhD, professor of behavioral sciences and of management and policy Sciences, school of Public Health, University of Texas-Austin.