Health Care Disparities Persist
Between Whites and Minorities
Research Finds Differences in Accessing Care

WASHINGTON, April 11 - Despite public and private-sector efforts to ensure that all consumers have equal access to health care, certain minority groups continue to experience greater difficulty getting the care they need than white Americans, according to research conducted under The Robert Wood Johnson Foundation's Changes in Health Care Financing and Organization (HCFO) initiative. An individual's income level, educational attainment, and race/ethnicity can make a difference in whether or how he or she accesses the health care system, research indicates.

"It is no secret that, for a variety of socioeconomic reasons, racial and ethnic minorities do not have comparable access to health care services as whites," says Anne K. Gauthier, director of the HCFO program. "Research that explores why these populations continue to experience disparities is gaining momentum, but more evidence-based studies are needed to identify workable solutions."

The findings of three HCFO-funded research projects on disparities offer insight into various aspects of the problem. Research at the University of Rochester, for example, indicated that HMO enrollment seemed to lessen the effect of patients' level of education in driving health care disparities. HMO enrollees with various levels of educational attainment had similar utilization rates for surgical procedures, visits to specialists, and access to mental health services. For those with indemnity insurance, however, education made quite a difference; people with less than a high school education had half the odds of seeing a specialist for their last doctor's visit than did college graduates.

"HMOs' population focus, their emphasis on quality, and their accountability to accreditation organizations makes them better positioned than indemnity plans to drive appropriate utilization behavior," says Kevin Fiscella, M.D., lead investigator for the project. By identifying disparities among two groups that were insured, he says, the study dispels the myth that disparities are simply a result of lack of health insurance.
For more information, access HCFO's findings brief on this research at: www.hcfo.net/pdf/findings0402.pdf.

In earlier work on disparities funded by HCFO, researchers found that individual-level variables, such as a person's income, age, and education, may have a greater effect on whether they purchase non-group insurance than broader environmental factors, such as the presence or strength of a safety net and housing segregration. Because employer-sponsored (i.e., group) insurance is not available for many minorities, it is important for researchers to identify potential incentives that may lead to take-up of non-group insurance among these populations. For more information, visit www.hcfo.net/pdf/findings0102.pdf.

Another HCFO-funded project found that certain cultural differences between whites and non-English-speaking Hispanics may skew survey results measuring access to care. Specifically, non-English-speaking Hispanics do not interpret "need" in the same way as non-Hispanic whites, and therefore likely underreported their access problems. For more details, see www.hcfo.net/pdf/research0701.pdf.

"With these projects, we hope that researchers can inform policymakers about the realities of disparities and dispel the myths," says Gauthier. "Only then can appropriate action be taken to level the playing field for all health care consumers."

The Academy for Health Services Research and Health Policy (www.academyhealth.org) serves as the national program office for the HCFO program (www.hcfo.net). The program's mission is to serve as a bridge between the policy and research communities, funding the production of useable and timely information on health care policy and market developments for dissemination to stakeholders in the public and private policy arenas.

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