Race a bigger health care barrier than insurance status
Race appears to be a larger factor in disparities in health care use than whether or not a person has health insurance, finds a new study in the Journal of Health Care for the Poor and Underserved. Blacks, Hispanics, and especially Asians are less likely than non-Hispanic Whites to access health care even if they have health insurance. However, having health insurance does increase the use of the health care system in minority populations.
"Comparing people with health insurance to those without showed that racial disparities still exist," said Chia-Hung Chou, Ph.D., research assistant professor in the Department of Medicine at The University of Chicago and a lead author on the study. "The disparity is still there and we are not sure why this is the case."
These findings are from an analysis of data collected by the National Health Interview Study, a survey that included questions about insurance status and the use of health care services. The study looked at responses from more than 27,000 people in 2010.
About 87 percent of non-Hispanic White adults surveyed had private or public health insurance, compared to about 60 percent of Hispanics, 75 percent of Blacks and almost 82 percent of Asians. However, while about 22 percent of Whites with health insurance used health services during a specified period of time, only 17.5 percent of insured Hispanics and about 20 percent of insured Blacks did so. Strikingly, only about 14 percent of Asians with health insurance used health services.
Having health insurance still made a difference in health care utilization, according to the study. Only 8.7 percent of uninsured Whites, 4.7 percent of uninsured Hispanics, 7.1 percent of uninsured Blacks and 4.1 percent of uninsured Asians had at least one visit with a health care professional during the study period.
"Health insurance definitely helped people utilize more health care services. We really see that clearly," he said. But there appear to be other factors outside of having health insurance, he said. "Health insurance alone may not do the trick."
"The fact that Hispanics, African-Americans and Asians do not see physicians despite having insurance does not surprise me," said Carlos Gonzales, M.D., professor of family medicine at the University of Arizona in Tucson. "The only thing that did surprise me was that Asian people, whether insured or uninsured, were even less likely to see physicians than Hispanics."
One factor may be that minority communities may not have enough health professionals, he said. "If you have insurance but not a lot of physicians in your area, it is not going to help you," Gonzales said. In addition, many minority groups distrust the entire health care system. "If you do not trust the health care system, you only go when you have to," he said. "The way physicians can counteract distrust in these communities is through enhanced cultural humility, sensitivity and competency which is being taught in greater detail in most medical schools," he noted.