Disparities in health care by race, ethnicity, and language among the insured

Department of Family Medicine, University of Rochester School of Medicine, New York, USA.
Medical Care (Impact Factor: 3.23). 02/2002; 40(1):52-9.
Source: PubMed


Racial and ethnic disparities in health care have been well documented, but poorly explained.
To examine the effect of access barriers, including English fluency, on racial and ethnic disparities in health care.
Cross-sectional analysis of the Community Tracking Survey (1996-1997).
Adults 18 to 64 years with private or Medicaid health insurance.
Independent variables included race, ethnicity, and English fluency. Dependent variables included having had a physician or mental health visit, influenza vaccination, or mammogram during the past year.
The health care use pattern for English-speaking Hispanic patients was not significantly different than for non-Hispanic white patients in the crude or multivariate models. In contrast, Spanish-speaking Hispanic patients were significantly less likely than non-Hispanic white patients to have had a physician visit (RR, 0.77; 95% CI, 0.72-0.83), mental health visit (RR, 0.50; 95% CI, 0.32-0.76), or influenza vaccination (RR, 0.30; 95% CI, 0.15-0.52). After adjustment for predisposing, need, and enabling factors, Spanish-speaking Hispanic patients showed significantly lower use than non-Hispanic white patients across all four measures. Black patients had a significantly lower crude relative risk of having received an influenza vaccination (RR, 0.73; 95% CI, 0.58-0.87). Adjustment for additional factors had little impact on this effect, but resulted in black patients being significantly less likely than non-Hispanic white patients to have had a visit with a mental health professional (RR, 0.46; 95% CI, 0.37-0.55).
Among insured nonelderly adults, there are appreciable disparities in health-care use by race and Hispanic ethnicity. Ethnic disparities in care are largely explained by differences in English fluency, but racial disparities in care are not explained by commonly used access factors.

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    • "Disparities caused primarily by low insurance rates among Latinos may be remedied by increasing insurance coverage, which is expected after the Affordable Care Act (ACA) enacted in 2010 gets fully implemented and families begin to enroll in insurance exchanges or the expansion of the federal Medicaid program for children in low-income households. In contrast, if limited English proficiency is the primary factor that contributes to health-care disparities, a source of disparities that is well-documented in the literature, coverage may be insufficient to narrow the gap (Clemans-Cope et al., 2012; Fiscella et al., 2002; Morales et al., 1999). In the latter scenario, resources should be allocated toward strategies to address linguistic and cultural barriers, improve communication, or intervene in other ways that will reduce barriers among parents and children with limited English proficiency. "
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