Racial and Ethnic Differences in Access to Medical Care

Abstract

The authors' review of the health services literature since the release of the landmark Report of the Secretary's Task Force Report of Black and Minority Health in 1985 revealed significant differences in access to medical care by race and ethnicity within certain disease categories and types of health services. The differences are not explained by such factors as socioeconomic status (SES), insurance coverage, stage or severity of disease, comorbidities, type and availability of health care services, and patient preferences. Under certain circumstances when important variables are controlled, racial and ethnic disparities in access are reduced and may disappear. Nonetheless, the literature shows that racial and ethnic disparities persist in significant measure for several disease categories and service types. The complex challenge facing current and future researchers is to understand the basis for such disparities and to determine why disparities are apparent in some but not other disease categories and service types.

The National Institute on Aging Health Disparities Research Framework

“…One very important resource for protecting health is access to quality health care. 18 While health care availability and quality are critical for accurate diagnosis and treatment of disease, this resource may be influenced by residential segregation that affects health insurance, quality nursing homes and availability of hospice care. 19,20 For example, immigrant populations that migrate to the United States and experience residential segregation may endure barriers to health care because of lack of insurance, not being eligible for government programs and limited access in their area.…”

“…tural bias and inadequate access to quality health care, 18 this population group has historically created and participated in productive networks of exchange and support. These networks are particularly important for individuals facing harsh circumstances such as unemployment and illness.…”

Does Access to Care Still Affect Health Care Utilization by Immigrants? Testing of an Empirical Explanatory Model of Health Care Utilization by Korean American Immigrants with High Blood Pressure

“…[2, 3] Another assumption of our model was the belief that health care utilization patterns of immigrants need to be interpreted in the context of migration in an ecological sense, since immigration itself is a stressful event that affects overall health care-seeking behavior [20, 22, 28]. We also carefully reviewed the literature to identify known factors that influence health care utilization by immigrant populations in general, such as socioeconomic status, health insurance coverage [30], and the physical and mental health status of the individuals [17, 25]. Several important acculturation indicators, such as years of residence in the US, personal resources, and living arrangements (e.g., living with a spouse) [28, 32] have also been identified as barriers to health care utilization that are more pronounced among ethnic minority immigrants because of the cultural and language barriers that exist.…”

Evidence of accelerated aging among African Americans and its implications for mortality

“…A number of factors have been shown to contribute to racial differences in morbidity and mortality: socioeconomic status (SES) (Hayward, Crimmins, Miles, et al, 2000; Franks, Muennig, Lubetkin, et al, 2006), neighborhood (Williams & Collins, 2001; Acevedo-Garcia, Ospuk, McArdle, et al, 2008), availability of quality healthcare (Mayberry, Mili, & Ofili, 2000; 2008 National Healthcare Disparities Report, 2009), behaviors (Jackson, Knight, & Raffery, 2010), and psychological stress (McEwen, 1998). Over time, these factors have the ability to get “under the skin” and alter physiological functioning (Taylor, Repetti, & Seeman, 1997; Kuzawa & Sweet, 2009).…”