An Overview: Eliminating Racial, Ethnic, and SES Disparities in Health Care
De Lew, Nancy, Weinick, Robin M., Health Care Financing Review
Since the 1985 landmark report of the Department of Health and Human Services Secretary's Task Force on Black and Minority Health (United States Task Force on Black and Minority Health, 1985) that focused attention on excess mortality rates among many minority groups, there has been a proliferation of studies and reports on racial and ethnic differences in access to and use of health services (Mayberry et al., 1999). The evidence is clear--race makes a difference. Race and ethnicity are associated with consistent patterns of health services use and health outcomes, with minority groups frequently experiencing a substantial disadvantage.
Noting the substantial economic differences between various racial and ethnic groups, income and health insurance coverage are frequently cited as potential explanations for these disparities. However, a growing body of research has demonstrated that these racial and ethnic differences persist even when differences in income and health insurance are held constant. For example, among the nearly 70 million Americans whose health care services are financed by Medicare and Medicaid, there are persistent racial and ethnic disparities in access to care, health care utilization, and health outcomes (Ayanian, et al., 1999a; Ayanian et al., 1999b; McBean and Gornick 1994; Gornick, et al., 1996; Mustard et al., 1996; Fielding, Cumberland, and Pettitt, 1994; Schoendorf et al., 1992; Kotelchuck, 1994). There are also racial differences in utilization within the Veterans Administration health system (Whittle et al., 1993). Other research has demonstrated that disparities in access to care and the use of health care services remain substantial after controlling for health insurance status, and that health insurance coverage and income explain only a comparatively small proportion of these disparities (Weinick, Zuvekas, and Cohen, 2000; Zuvekas and Weinick, 1999; Cornelius, 1993; Wood et al., 1990).
Given the consistency of these findings regarding income and health insurance coverage, researchers have begun to explore other potential explanations for racial and ethnic disparities in health. The case of cardiovascular disease is illustrative. Over the past 30 years, heart disease mortality rates have been decreasing across all racial and ethnic groups, but the decline has been much greater for white Americans (National Center for Health Statistics, 1998). Black Americans continue to have the highest mortality rates for heart disease--about 50 percent higher than that of white Americans (National Center for Health Statistics, 1998). Research has shown that one reason behind these differences may be the fact that black Americans are less likely to undergo medical procedures and surgery known to increase life expectancy (Peterson et al., 1994; Sedlis et al., 1997). Although the gap between black and white patients in diagnostic cardiac catheterization rates has narrowed over time, large racial disparities in the treatment of heart disease with angioplasty and coronary bypass graft surgery persist (Whittle et al., 1993). Even after controlling for factors such as, clinical characteristics (Maynard et al., 1986), and insurance status (Wenneker and Epstein, 1989), racial differences in the use of cardiac procedures remain.
Despite the knowledge gained from such research, racial and ethnic disparities in health and health care persist. For example, Hispanic Americans are substantially more likely than white Americans to be uninsured, with about 1 in 3 Hispanic Americans being uninsured in 1997 (Vistnes and Zuvekas, 1999). Hispanic Americans were also far more likely to lack a usual source of health care than any other group in 1996, and families headed by Hispanic Americans were the most likely to report barriers to receiving needed care (Weinick, Zuvekas, and Drilea, 1997). Even when admitted to the hospital for the same condition, Hispanic Americans were often significantly less likely to receive major therapeutic procedures than white Americans (Andrews and Elixhauser, 1998). …