Original Article

Access to Medical Care, Dental Care, and Prescription Drugs: The Roles of Race/Ethnicity, Health Insurance, and Income

Authors: Leiyu Shi, DrPH, MBA, MPA, Lydie A. Lebrun, MPH, Jenna Tsai, EdD

Abstract


Background: After accounting for socioeconomic factors and other demographic characteristics, racial/ethnic disparities in access to care were examined.


Methods: Using nationally representative data on 34,403 individuals from the 2004 Medical Expenditure Panel Survey (MEPS), multiple logistic regression analyses for five outcome measures were conducted: self-reports of being unable to get medical care, dental care, or prescriptions in the past year; and having no doctor or dentist visits in the past year. The main independent variables were race/ethnicity, income, and insurance status.


Results: Blacks and Hispanics were less likely to report difficulties in accessing medical care, dental care, and prescriptions as compared to whites. These disparities occurred primarily among the uninsured and Medicaid insured. More objective measures of utilization (ie, no doctor visit or dental visit during the past year) showed that minorities experienced less access than whites.


Conclusions: Racial/ethnic disparities in access to care persist, and cannot be entirely explained by socioeconomic differences. In addition, the nature of these disparities depends on the socioeconomic position of racial/ethnic groups as well as the access measure used.



This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1.Agency for Healthcare Research and Quality. 2006 National Healthcare Disparities Report. Rockville, MD, U.S. Department of Health and Human Services, 2006.
2.Smedley B, Stith A, Nelson A. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC, Institute of Medicine, 2003.
3.Centers for Disease Control and Prevention (CDC). Access to health care and preventive services among Hispanics and non-Hispanics—United States, 2001–2002. MMWR Morb Mortal Wkly Rep 2004;53:937–941.
4.Berdahl TA, Kirby JB, Stone RA. Access to health care for nonmetro and metro Latinos of Mexican origin in the United States. Med Care 2007;45:647–654.
5.Brousseau DC, Hoffmann RG, Yauck J, et al. Disparities in latino children in the timely receipt of medical care. Ambul Pediatr 2005;5:319–325.
6.Fiscella K, Franks P, Doescher MP, et al. Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care 2002;40:52–59.
7.Gavin NI, Adams EK, Hartmann KE, et al. Racial and ethnic disparities in the use of pregnancy-related health care among Medicaid pregnant women. Matern Child Health J 2004;8:113–126.
8.Greenberg G, Brandon WP, Schoeps N, et al. Medicaid managed care and racial differences in satisfaction and access. J Health Care Poor Underserved 2003;14:351–371.
9.Shi L, Stevens GD. Disparities in access to care and satisfaction among U.S. children: the roles of race/ethnicity and poverty status. Public Health Rep 2005;120:431–441.
10.Zuckerman S, Haley J, Roubideaux Y, et al. Health service access, use, and insurance coverage among American Indians/Alaska Natives and Whites: what role does the Indian Health Service play? Am J Public Health 2004;94:53–59.
11.Weinick RM, Zuvekas SH, Cohen JW. Racial and ethnic differences in access to and use of health care services, 1977 to 1996. Med Care Res Rev 2000;57(suppl 1):36–54.
12.Waidmann TA, Rajan S. Race and ethnic disparities in health care access and utilization: an examination of state variation. Med Care Res Rev 2000;57(suppl 1):55–84.
13.Abraído-Lanza AF, Chao MT, Gammon MD. Breast and cervical cancer screening among Latinas and non-Latina whites. Am J Public Health 2004;94:1393–1398.
14.Goel MS, Wee CC, McCarthy EP, et al. Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care. J Gen Intern Med 2003;18:1028–1035.
15.Hewitt M, Devesa SS, Breen N. Cervical cancer screening among U.S. women: analyses of the 2000 National Health Interview Survey. Prev Med 2004;39:270–278.
16.Sambamoorthi U, McAlpine DD. Racial, ethnic, socioeconomic, and access disparities in the use of preventive services among women. Prev Med 2003;37:475–484.
17.Ayanian JZ, Weissman JS, Schneider EC, et al. Unmet health needs of uninsured adults in the United States. JAMA 2000;284:2061–2069.
18.Jovanovic Z, Lin CJ, Chang CC. Uninsured vs. insured population: variations among nonelderly Americans. J Health Soc Policy 2003;17:71–85.
19.Litaker D, Cebul RD. Managed care penetration, insurance status, and access to health care. Med Care 2003;41:1086–1095.
20.McBride DC, Drumm RD, Terry-McElrath Y, et al. Back to basics: the role of health insurance in getting a physical exam. Soc Work Health Care 2005;42:93–106.
21.Zlotnick C, Soman LA. The impact of insurance lapse among low-income children. J Urban Health 2004;81:568–583.
22.Damiano P, Willard JC, Momany ET, et al. The impact of the Iowa S-SCHIP program on access, health status, and the family environment. Ambul Pediatr 2003;3:263–269.
23.Feinberg E, Swartz K, Zaslavsky A, et al. Family income and the impact of a children's health insurance program on reported need for health services and unmet health need. Pediatrics 2002;109:E29.
24.Guendelman S, Angulo V, Oman D. Access to health care for children and adolescents in working poor families: recent findings from California. Med Care 2005;43:68–78.
25.Slifkin R, Freeman V, Silberman P. Effect of the North Carolina State Children's Health Insurance Program on beneficiary access to care. Arch Pediatr Adolesc Med 2002;156:1223–1229.
26.Szilagyi PG, Dick AW, Klein JD, et al. Improved access and quality of care after enrollment in the New York State Children's Health Insurance Program (SCHIP). Pediatrics 2004;113:e395–e404.
27.Akers AY, Newmann SJ, Smith JS. Factors underlying disparities in cervical cancer incidence, screening, and treatment in the United States. Curr Probl Cancer 2007;31:157–181.
28.Kelley E, Moy E, Stryer D, et al. The national healthcare quality and disparities reports: an overview. Med Care 2005;43(3 suppl):I3–I8.
29.Agency for Healthcare Research and Quality. MEPS-HC Sample Design and Data Collection Process. Rockville, MD, AHRQ, 2008. Available at: http://www.meps.ahrq.gov/mepsweb/survey_comp/household.jsp. Accessed June 15, 2009.
30.Aday LA, Andersen RM. Equity of access to medical care: a conceptual and empirical overview. Med Care 1981;19(12 suppl):4–27.
31.LaVeist TA, Nickerson KJ, Bowie JV. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Med Care Res Rev 2000;57(suppl 1):146–161.
32.Lurie N, Zhan C, Sangl J, et al. Variation in racial and ethnic differences in consumer assessments of health care. Am J Manag Care 2003;9:502–509.
33.van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians' perceptions of patients. Soc Sci Med 2000;50:813–828.
34.Williams D. Race, socioeconomic status, and health: the added effects of racism and discrimination. Ann N Y Acad Sci 1999;896:173–188.