Center for Studying Health System Change

Health Insurance Gap Plays Major Role in Minority Access-to-Care Disparities

Uninsured Latinos and African Americans Face More Difficulty Getting Care Than Uninsured Whites

News Release
June 19, 2002

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ASHINGTON, D.C.—Ethnic and racial disparities in access to medical care among uninsured working-age Americans are much greater than disparities among insured people, according to a national tracking study issued today by the Center for Studying Health System Change (HSC).

Gaps in access to medical care between uninsured Latinos and African Americans and uninsured whites generally are almost double those between insured minorities and insured whites, according to results from HSC’s Community Tracking Study Household Survey, a nationally representative survey involving about 60,000 people in 33,000 families.

The larger access gaps—as measured by whether people have a regular health care provider and have seen a doctor in the last year-between uninsured minorities and uninsured whites indicate health insurance plays a more important role for minorities than whites in getting health care, the study found. Reduced access to medical care can lead to diagnosis and treatment delays and contribute to well-documented disparities in minority health.

"Health insurance is the key that opens the door of the health care system for most working-age Americans, but especially for Latinos and African Americans," said J. Lee Hargraves, Ph.D., the study’s author and a senior researcher at HSC, a nonpartisan policy research organization funded exclusively by The Robert Wood Johnson Foundation.

For example, 31.1 percent of uninsured Latinos and 36 percent of uninsured African Americans reported having a regular health care provider in 2001, compared with 51.4 percent of uninsured whites—for an access gap of more than 20 percentage points between uninsured Latinos and uninsured whites.

Among insured people, gaps between minorities and whites were still significant but were much smaller—66.8 percent of Latinos and 70.8 percent of African Americans had a regular health care provider, compared with 78.1 percent of whites. The access gap between insured Latinos and insured whites was about 11 percentage points.

Almost one in three Latinos and one in five African Americans lacked health insurance in 2001, compared with about one in 10 white Americans. The study findings are detailed in a new HSC Tracking Report—The Insurance Gap and Minority Health Care, 1997-2001—is available by clicking here.

"Health insurance clearly plays a more important role for working-age African Americans and Latinos and their ability to get care than for white Americans," Hargraves said.

While the proportion of white Americans without health insurance declined from 12.5 percent in 1997 to 10.9 percent in 2001, coverage rates for Latinos and African Americans did not improve significantly, with 32 percent of Latinos and 18.7 percent of African Americans uninsured in 2001.

A key factor in uninsured whites’ greater ability to access care is they tend to have higher incomes. In 2001, more than half of uninsured whites had incomes above 200 percent of poverty, or $17,180 annually for a single person. In contrast, only one-quarter of uninsured Latinos and one-third of uninsured African Americans had incomes that high.

"Reducing disparities in minority health care will be difficult without narrowing the health insurance gap," said HSC Vice President Len Nichols, Ph.D.

In 2001, uninsured Latinos (35.7%) and African Americans (47.1%) were less likely to have seen a doctor in the last year than uninsured whites (53.3%), for an access gap of almost 18 percentage points between uninsured Latinos and uninsured whites. Among the insured, Latinos (74.6%) were still less likely to have seen a physician in the last year than whites (82.3%), but the access gap between the two was less than 8 percentage points. About 80 percent of insured African Americans saw a physician in the previous year.

Among both insured and uninsured people, African Americans and Latinos consistently had worse access to care than whites between 1997 and 2001. Minorities were less likely to have a regular health care provider, saw a doctor less often and lagged behind whites in seeing specialists.

"Despite the booming economy and significant national attention to reducing minority health disparities, gaps in access to medical care between whites and minorities failed to shrink between 1997 and 2001," Nichols said.

The study also found that Latinos and African Americans rely more on hospital emergency rooms for care, illustrating the possible consequence of less access in other care settings. In 2001, 6.6 percent of whites’ visits with a health care provider took place in emergency rooms, compared with 7.8 percent of Latinos’ visits and 9.6 percent of African Americans’ visits.

Moreover, uninsured Latinos are increasing the proportion of their care that occurs in emergency rooms. In 2001, nearly 10 percent of uninsured Latinos’ visits with health care providers took place in emergency rooms, up from 6.6 percent in 1997.

Stakeholder Comments on the HSC Study

Lucille C. Perez, M.D., president, National Medical Association
"Coming on the heels of the Institute of Medicine study showing that African Americans receive inferior care, the HSC study further underscores the urgency for action to expand health coverage. Until we are committed to assuring equal access to quality care, health disparities will continue to rob this country of its most valuable resource—its people."

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded by The Robert Wood Johnson Foundation and affiliated with Mathematica Policy Research, Inc.