Explaining racial and ethnic disparities in health care.
OBJECTIVE
The substantial racial and ethnic disparities in access to and use of health services are well documented. A number of studies highlight factors such as health insurance coverage and socioeconomic differences that explain some of the differences between groups, but much remains unexplained. We build on this previous research by incorporating additional factors such as attitudes about health care and neighborhood characteristics, as well as separately analyzing different Hispanic subgroups.


METHODS
We use the Oaxaca-Blinder regression-based method to decompose differences among racial and ethnic groups in 3 measures related to access, quantifying the portion explained by each of a number of underlying characteristics and the differences that remain unexplained. We use data from the 2000 and 2001 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the noninstitutionalized U.S. population. We link these data to detailed neighborhood characteristics from the Census Bureau and local provider supply data from the Health Services Resource Administration (HRSA).


RESULTS
Consistent with earlier studies, we find insurance status and socioeconomic differences explain a significant part of the disparities. Additionally, neighborhood racial and ethnic composition account for a large portion of disparities in access, and language differences help explain observed disparities in the use-based access measure. However, much of the differences between racial and ethnic groups remain unexplained. We also found substantial variation in the level of disparities among different groups of Hispanics.


CONCLUSIONS
Researchers and policymakers may need to broaden the scope of factors they consider as barriers to access if the goal of eliminating disparities in health care is to be achieved.
Kirby
James B
JB
Center for Cost, Financing and Access Trends, Agency for Healthcare Research and Quality, Rockville, Maryland 20850, USA. jkirby@ahrq.gov
Taliaferro
Gregg
G
Zuvekas
Samuel H
SH
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001294:Attitude to Health / Q000208:ethnology*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D015273:Insurance Selection Bias; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000706:statistics & numerical data; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D014481:United States; D044465:White People / Q000706:statistics & numerical data*