Variation in health services utilization among ethnic populations

Abstract

Research R acial and ethnic disparities in the use of health services and in health outcomes have been extensively studied and well documented in the United States and the United Kingdom. Studies from both countries reveal that black, Hispanic and Asian people are less likely to access health care and experience more barriers than people who are not visibly members of ethnic minorities -that is, white people.1-7 The factors underlying ethnic disparities in health service usage are complex and could include such variables as health insurance coverage, physicians' attitudes toward minority patients, language, poverty, transportation, education, familiarity with the health care delivery system, and the degree and kind of family support. 3,6-17The evidence from the United States and the United Kingdom cannot automatically be generalized to Canada, and there is a need for rigorous study of Canadian ethnic populations and their use of health services. The first reason is that much of the US and UK literature on this topic is broadly categorized into "black" and "Hispanic" populations. The United States, the United Kingdom and Canada have different racial and ethnic population compositions because of historical factors. The legacy of slavery in the United States and of colonization in the United Kingdom have led to a higher proportion of persons identified as black. In contrast, Canada has many Asian people in its ethnic make-up, because in recent years a large proportion of immigrants to Canada have come from Asia (59%), with a small proportion from Central and South America and the Caribbean (11%) and Africa (8%).18 At present, the 3 largest visible minority groups in Canada are Chinese (mainly from Hong Kong, Taiwan and mainland China), South Asian (from Asian India, Pakistan, Bangladesh and Sri Lanka) and black people.The second reason is that culture, health status and sociodemographic characteristics even in the same racial or ethnic population may differ between Canada and the United States or the United Kingdom. In recent years, Canada has selected immigrants with high education, strong technical skills and correspondingly favourable health status, with only a relatively small number of immigrants arriving as refugees; US and UK ethnic minorities may differ in those respects. The third reason is that the Canadian health system differs fundamentally from the US health system, and somewhat from the parallel public and private systems of the United Kingdom. Interpretation: : Use of health services in Canada varies considerably by ethnicity according to type of service. Although there is no evidence that members of visible minorities use general physician and specialist services less often than white people, their utilization of hospital and cancer screening services is significantly less. CMAJ 2006;174(6):787-91 Abstract

Invasive cardiac procedure use and mortality among South Asian and Chinese Canadians with coronary artery disease

“…Quan et al (24) analyzed a Canadian national survey and found that ethnic minorities were just as likely as white respondents to report seeing a family physician/general practitioner or a specialist physician, where a family physician referral is required. Hemmelgarn et al (25) compared the use of peritoneal dialysis among East Asian, South Asian and white patients with end-stage renal disease initiating dialysis therapy in Canada.…”

Immigrants and the utilization of hospital emergency departments

“…A number of studies [8,20,21] have demonstrated inequities in access to health care services among immigrants compared to the host population in developed nations. These studies have shown that immigrants tend to underutilize health care services compared to the host population.…”

Measuring Health Services Utilization in Ethnic Populations: Ethnicity and Choice of Frameworks

“…16 Despite its wide spread use in health services research, the Aday-Andersen framework 7 is merely a theoretical framework for analyzing the factors rather than providing a mathematical model with precise variables or providing precise methods to be used. The choice of factors depends on the extent of prior research, the research question, the purpose of the study, and data availability.…”

“…Characteristics of both studies included use of multi-stage complex sampling procedures, a cross-sectional survey, one time random telephone survey (land line only) of none institutionalized adults (very low income populations, who may be less likely to own telephones, may be under sampled). None of the authors made mention of a framework in the introduction and design sections (Quan et al 16 cited Aday-Andersen under interpretation). This omission of framework is probably justified given the secondary nature of the data.…”

“…7 The findings from these studies demonstrated the dimensions of health services research and the potential influence on health policy decisions. For example, Quan et al 16 found that use of health services varies considerably by ethnicity according to type of service; meanwhile Lasser et al 18 showed that United States residents are less able to access care than are Canadians, and that universal coverage appears to reduce most disparities in access to care. This latter finding is useful at the macro level (e.g., the institutionalization of universal coverage at the national level in the case of Canada).…”