Although the United States has a nationwide healthcare delivery system, unfortunately, not all Americans have equal access to it. Many Americans, particularly minorities, face socioeconomic, geographic, cultural and language barriers to care that prevent them from receiving the best healthcare America has to offer, and such barriers adversely affect African Americans in particular. These barriers result in unmet healthcare needs, delayed and denied medical treatment, and the delivery of sub-standard quality care. Because African Americans have less access to care, they have poorer health status, higher rates of morbidity and mortality, and greater economic hardship. In 2006, African Americans were 87 percent more likely to report they were in fair or poor health, in comparison to whites. They were also 29 percent more likely to die and had higher rates of hypertension, diabetes and stroke. l While African Americans have similar rates of cancer in comparison to whites, they were more likely to die from the disease because their cancer was diagnosed at later stages, and they received less care. On average, African Americans spent 16.5 percent of their income on medical care, compared to whites who spent 12.2 percent.2 However, despite spending a larger share of their income on medical care, African Americans face healthcare disparities.
Racial disparities in healthcare are well-documented.3 For the most part, African Americans receive less care and lower quality treatment than whites, and the problems that African Americans experience in the healthcare marketplace are due to patient, provider and health system barriers to care. Patient factors include treatment preferences and refusals, medical mistrust, and health literacy and provider factors include prejudice and bias, clinical uncertainty and miscommunication, stereotyping, and cultural incompetence. In addition, health system factors include lack of universal health care coverage, geographic barriers of care, poorly functioning referral networks, and under-resourced minority-serving and safetynet institutions.
Much attention has been paid to addressing patient and providerrelated factors. To address patient-related factors, health literacy programs, culturally sensitive health education materials and patient-decision making tools have been developed and implemented in healthcare settings.4 To address provider-related factors, cultural competency-training curriculum have been developed and implemented in medical schools, hospitals and health systems.5 In addition, researchers have studied physician-patient encounters to develop interventions to improve communication during the office visit.6 Also, scholars have developed surveys and evaluation tools that determine whether physicians have implicit racial biases that affect patient care.7 While these efforts are laudable, they will not alone remedy the problems African Americans experience when accessing the healthcare delivery system. To improve access to care, system-level barriers must be addressed.
African Americans' Problems Accessing Quality Healthcare
Although some progress has been made, African Americans still face problems accessing primary care.8 Compared to whites, African Americans were 12 percent less likely to have a usual primary care provider and 26 percent less likely to have a provider visit during the year after controlling for age, gender, socioeconomic status and location. According to a medical study, African-American children were less likely to have a physician visit, more likely to have an emergency room visit, less likely to have a preventative dental visit and less likely to use prescribed medication, when compared to white children.9 Other studies have found that racial differences in health insurance coverage, the availability of physicians and income have been identified as major contributors to disparities in primary care.10
Exacerbating this current …