Accessibility of Health Care

Definition and Scope of Health Care Access

The health disparities and health care inequalities experienced by major American ethnic groups (compared with Caucasian Americans) have been well documented. Health disparities are defined as higher rates of chronic and disabling illness, infectious disease, and mortality experienced by members of ethnic minority groups compared with Caucasians. One of the most important factors contributing to health disparities is limited access to health care. Therefore, improving access to health care is considered one of the greatest opportunities for reducing health disparities in the United States.

Access to health care can be considered at two levels: primary access and secondary access. Primary access involves entry into the health care system and access to basic care. Secondary access involves the quality of care received by individuals with primary access. Primary and secondary health care access will be discussed with respect to four major cultural groups in the United States: African Americans, Hispanic Americans, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives. Primary access issues include health insurance rates and the accessibility of health care facilities. Secondary access issues include quality of care, access to specialists, access to culturally similar health care personnel, language barriers, and discrimination.

African Americans

Lack of insurance is considered the most significant barrier to health care, and for a majority of Americans, health insurance provided by employers makes health care affordable. The uninsured rate for African Americans under age 65 is 19.9%. Unemployment is [Page 4]strongly tied to the lack of insurance among African Americans; however, a disproportionate number of African American workers whose employers do not provide health insurance are also counted among the uninsured. Among African Americans, poverty and unemployment rates are 24.4% and 11.6%, respectively, compared with 8.2% and 5.6%, respectively, for Caucasians.

Another primary health care access issue for African Americans is the availability of health care providers. In poor, ethnic communities, there is a limited supply of health resources, primarily because patients in these communities cannot afford to pay for the services provided. As a result, health care facilities cannot be maintained. This reality has driven the creation of community health centers and hospital-based providers. Reduced geographic proximity to health care providers has a particularly strong impact on urban African American communities that rely heavily on public transportation, which increases the time and cost of accessing care.

A major secondary access issue is the quality of care received by African Americans. Inequalities in medical care exist even when African Americans have insurance plans that are similar to majority group members. For example, African American patients with health maintenance organization (HMO) insurance report more difficulty seeing a specialist and obtaining tests and treatment, suggesting that barriers exist well beyond entry into the health care system.

Another secondary access issue is the lower number of physicians from ethnic minority groups. This decreases health care access for minority patients because prospective patients are often reluctant to visit health care providers who may be racially or ethnically different from them.

Language barriers also influence secondary access. Patient–physician communication has been reported to be more problematic for African American patients than for Caucasian patients, even though both patients and physicians may speak the same language. Finally, discrimination is a major barrier to secondary access, affecting physicians' perceptions of patients as well as treatment decisions. For example, a negative perception of African American patients is associated with a lower likelihood of recommending treatment.

...