The authors examined changes in medical care experiences of racial/ethnic groups (non-Hispanic white, Asian and Pacific Islander, Hispanic, and non-Hispanic black) between 1996 and 2002, using data from the Household Component of Medical Expenditure Panel Surveys. Proportions and adjusted odds ratios for each group's primary care experience are presented. Comparisons are made between groups at each time period and within groups between the two time periods. Multivariable analyses control for demographic and socioeconomic characteristics, health care needs and source of care, and health insurance. Racial/ethnic minorities experienced worse medical care than non-Hispanic whites, but results differed among groups. Non-Hispanic blacks were no different from non-Hispanic whites and showed a slight improvement over time, except for lower odds of having a usual source of care and worse sociodemographic and health indicators. Hispanics had worse experiences than whites in 5 of 8 indicators in 2002 (vs. 3 in 1996). Asians assessed their experience as worse than that of whites in 6 of 8 indicators in 2002 (vs. 3 in 1996), yet had higher self-rated health and education than non-Hispanic whites. Disparities in medical care experience have increased for some groups, and efforts must be made to reduce financial and nonfinancial barriers to care for racial/ethnic minority populations.
References
1.
U.S. Department of Health and Human Services.The Initiative to Eliminate Racial and Ethnic Disparities in Health.Washington, DC, 2003.
2.
SmedleyB. D.StithA. Y., and NelsonA. R.l (eds.). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.National Academy Press, Washington, DC, 2002.
3.
HargravesJ. L., and HadleyJ.The contribution of insurance coverage and community resources to reducing racial/ethnic disparities in access to care. Health Serv. Res.38(3):809–829, 2003.
4.
ZuvekasS. H., and TaliaferroG. S.Pathways to access: Health insurance, the health care delivery system, and racial/ethnic disparities, 1996–1999. Health Aff. (Millwood)22(2):139–153, 2003.
5.
FarmerM. M., and FerraroK. F.Are racial disparities in health conditional on socioeconomic status?Soc. Sci. Med.60(1):191–204, 2005.
6.
RobbinsA. S.WhittemoreA. S., and ThomD. H.Differences in socioeconomic status and survival among white and black men with prostate cancer. Am. J. Epidemiol.151(4):409–416, 2000.
7.
CarlisleD. M.The effect of race and ethnicity on the use of selected health care procedures: A comparison of South Central Los Angeles and the remainder of Los Angeles county. J. Health Care Poor Underserved7:308–322, 1996.
8.
SheiferS. E.EscarceJ. J., and SchulmanK. A.Race and sex differences in the management of coronary artery disease. Am. Heart J.139(5):848–857, 2000.
9.
WeitzmanS.Gender, racial, and geographic differences in the performance of cardiac diagnostic and therapeutic procedures for hospitalized acute myocardial infarction in four states. Am. J. Cardiol.79(6):722–726, 1997.
10.
ShiL.Experience of primary care by racial and ethnic groups in the United States. Med. Care37(10):1068–1077, 1999.
11.
ClancyC. M., and StryerD. B.Racial and ethnic disparities and primary care experience. Health Serv. Res.36(6, Pt 1):979–986, 2001.
12.
StevensG. D., and ShiL.Racial and ethnic disparities in the quality of primary care for children. J. Fam. Pract.51(6):573, 2002.
13.
MoyE.Changes in usual sources of medical care between 1987 and 1992. J. Health Care Poor Underserved9:126–139, 1998.
14.
SatarianoW. A.BelleS. H., and SwansonG. M.The severity of breast cancer at diagnosis: A comparison of age and extent of disease in black and white women. Am. J. Public Health76(7):779–782, 1986.
15.
PolednakA. P., and FlanneryJ. T.Black versus white racial differences in clinical stage at diagnosis and treatment of prostatic cancer in Connecticut. Cancer70(8): 2152–2158, 1992.
16.
AshtonC. M.Racial and ethnic disparities in the use of health services: Bias, preferences, or poor communication?J. Gen. Intern. Med.18(2):146–152, 2003.
17.
LagomasinoI. T.Disparities in depression treatment for Latinos and site of care. Psychiatr. Serv.56(12):1517–1523, 2005.
18.
StarfieldB.Consumer experiences and provider perceptions of the quality of primary care: Implications for managed care. J. Fam. Pract.46(3):216–226, 1998.
19.
SafranD. G.Linking primary care performance to outcomes of care. J. Fam. Pract.47(3):213–220, 1998.
20.
CohenJ.Design and Methods of the Medical Expenditure Panel Survey Household Component.Agency for Health Care Policy and Research, Rockville, MD, 1997.
21.
CohenJ.Sample Design of the Medical Expenditure Panel Survey Household Component.Agency for Health Care Policy and Research, Rockville, MD, 1997.
22.
StevensG. D., and ShiL.Racial and ethnic disparities in the primary care experiences of children: A review of the literature. Med. Care Res. Rev.60(1):3–30, 2003.
23.
U.S. Census Bureau.Racial and Ethnic Classifications Used in Census 2000 and Beyond.Washington, DC, 2000.
24.
StarfieldB.Primary Care: Balancing Health Needs, Services and Technology.Oxford University Press, New York, 1998.
25.
GrossR.The relationship between primary care physicians' adherence to guidelines for the treatment of diabetes and patient satisfaction: Findings from a pilot study. Fam. Pract.20(5):563–569, 2003.
26.
AlazriM. H., and NealR. D.The association between satisfaction with services provided in primary care and outcomes in type 2 diabetes mellitus. Diabet. Med.20(6):486–490, 2003.
27.
AndersenR. M.Revisiting the behavioral model and access to medical care: Does it matter?J. Health Soc. Behav.36(1):1–10, 1995.
28.
WeinickR. M., and ZuvekasS. H.Experience of primary care by racial and ethnic groups. Med. Care38(4):447–448, 2000.
29.
SahaS.ArbelaezJ. J., and CooperL. A.Patient-physician relationships and racial disparities in the quality of health care. Am. J. Public Health93(10):1713–1719, 2003.
30.
BallJ. K., and ElixhauserA.Treatment differences between blacks and whites with colorectal cancer. Med. Care34(9):970–984, 1996.
31.
ShiL.GreenL. H., and KazakovaS.Primary care experience and racial disparities in self-reported health status. J. Am. Board Fam. Pract.17(6):443–452, 2004.
32.
ArmstrongK.Distrust of the health care system and self-reported health in the United States. J. Gen. Intern. Med.21(4):292–297, 2006.
33.
HallM. A.Trust in the medical profession: Conceptual and measurement issues. Health Serv. Res.37(5):1419–1439, 2002.
34.
ShinP.JonesK., and RosenbaumS.Reducing Racial and Ethnic Health Disparities: Estimating the Impact of High Health Center Penetration in Low-income Communities.GWU Center for Health Services Research and Policy, Washington, DC, 2004.
35.
EsperatM. C.Health disparities among Asian Americans and Pacific Islanders. Annu. Rev. Nurs. Res.22:135–159, 2004.
36.
JonesD.An exploratory study of language interpretation services provided by videoconferencing. J. Telemed. Telecare9(1):51–56, 2003.
37.
CoeytauxR. R.Racial disparities in health between white and African American family practice patients: Clinical implications. N. C. Med. J.65(6):330–334, 2004.
38.
LaVeistT. A.Beyond dummy variables and sample selection: What health services researchers ought to know about race as a variable. Health Serv. Res.29:1–16, 1994.
39.
LaVeistT. A. (ed.). Race, Ethnicity, and Health.Jossey-Bass, San Francisco, 2002.
40.
LampertR.Depressed autonomic nervous system function in African Americans and individuals of lower social class: A potential mechanism of race- and class-related disparities in health outcomes. Am. Heart. J.150(1):153–160, 2005.
41.
CrowR.The measurement of satisfaction with healthcare: Implications for practice from a systematic review of the literature. Health Technol. Assess.6(32), 2002.
42.
GwatkinD. R.BhuiyaA., and VictoraC. G.Making health systems more equitable. Lancet364(9441):1273–1280, 2004.
43.
BrowningC. R.CagneyK. A., and WenM.Explaining variation in health status across space and time: Implications for racial and ethnic disparities in self-rated health. Soc. Sci. Med.57(7):1221–1235, 2003.
