Health Disparities

Barriers to Addressing Healthcare Disparities

Barriers to accessing healthcare stem from many factors: personal, financial (uninsured or underinsured), language, geographic, sociocultural, the institutional arrangements of health systems, and the legal, regulating, and policy environment. Some of these factors may produce inconvenience and frustration, while others may actually prevent people from getting the healthcare they need. These barriers vary with population, location, and political situation and should be assessed by each community, especially those with medically under-served populations.

Overview

The basic contours of socioeconomic and ethnic and racial disparities in health are wellknown. Socioeconomic status is inversely correlated with virtually all the major indicators of health status, including functional impairments, self-rated health, and disease-specific morbidity and mortality. Moreover, research demonstrates that socioeconomic position in society is linked to health through a variety of pathways, including access to care, environmental exposures, and life stressors. Race and class are codeterminants of disparities in health, each having its own additive effect. Healthcare disparities are arguably a major cause of health disparities; they include poorer access to healthcare services and poorer quality of the healthcare services received. One explanation for the relationship between access to healthcare and health status for low-income minority groups is that they have less access to and make less use of healthcare services (including preventive care), and therefore, they suffer worse health status. For instance, minority groups may be less likely to have a usual physician or source of care, that is, a specific primary-care physician. Not having a usual physician or usual clinic for routine healthcare may be due to a variety of factors such as lack of participating medical providers, lack of knowledge or trust in the medical system, lack of understanding about the importance of preventive care, lack of financial resources, or a combination of these factors. The explanations and specific causal factors are likely to vary for each group.

Disparities in Access

Existing disparities in healthcare access based on minority status, health status, and urban versus rural status are well documented. National surveys have consistently found that Blacks, despite their lower ambulatory-care use and lower access to a usual source of care, were less likely than Whites to report problems in getting needed care and were also equally likely to report that they were very satisfied that their family could get the healthcare they needed. In contrast, Hispanics were more likely to report problems with family members getting needed treatment and less likely to report problems getting care for themselves. There are, in other words, different perceptions of access difficulties between groups.

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