title: Race/ethnicity, insurance, income and access to care: the influence of health status.
abstract: OBJECTIVE
  To examine health care access disparities with regard to health status and presence of functional limitations, a common measure of disability and multimorbidity, after controlling for individual's race/ethnicity, insurance status and income in the U.S. using the latest survey data.
  
  
  METHODS
  Using data from the 2009 Family Core component of the National Health Interview Survey (NHIS), we examined six measures of access to care in the twelve months prior to the interview. Covariates included self-perceived health status and the presence of functional limitations, race/ethnicity, insurance status, income, and other socioeconomic characteristics. Multiple logistic regressions were used to examine the associations.
  
  
  RESULTS
  People with functional limitations or worse health status experience greater barriers to access. Insurance status was the single factor that was associated with all six measures of access. Disparities among racial/ethnic groups in most access indicators as well as income levels were insignificant after taking into account individuals' health status measures.
  
  
  CONCLUSIONS
  Interventions to expand insurance coverage and the Patient Protection and Affordable Care Act are expected to contribute to reducing disparities in access to care. However, to further improve access to care, emphasis must be placed on those with poorer health status and functional limitations.
authors.affiliation: School of Nursing, National Yang Ming University, Taipei 112, Taiwan. fang@ym.edu.tw
authors.forename: Tze-Fang
authors.initials: TF
authors.lastname: Wang
authors.forename: Leiyu
authors.initials: L
authors.lastname: Shi
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Nie
authors.forename: Jinsheng
authors.initials: J
authors.lastname: Zhu
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D005006:Ethnicity / Q000706:statistics & numerical data; D006304:Health Status; D006306:Health Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D014481:United States