1. Jennie J Kronenfeld. PhD Arizona State University
Health Care Disparities in the United States

2. Institute of Medicine Definition – Health Care Disparities
Differences in treatment or access between population groups that cannot be justified by different preferences for services or differences in health.

3. Race/Ethnicity and SES Factors and Disparities
Race/ethnicity - race and also Hispanic/Latino vs. non_hispanic white
SES Factors - occupation, income and education (less likely use occupation)

4. Past efforts and Data Collection Efforts
Healthy People reports
Public Law , the Healthcare Research and Quality Act of 1999 –
directed the Agency for Healthcare Research and Quality (AHRQ) to develop two annual reports, one focused on quality and one focused on disparities
National Healthcare Disparities Report (2004 and later years)
IOM Report, Unequal Treatment: Confronting Racial and Economic Disparities in Healthcare

5. Components of Health Care Access
Access to health care means having "the timely use of personal health services to achieve the best health outcomes" (IOM, 1993). Attaining good access to care requires three discrete steps:
Gaining entry into the health care system.
Getting access to sites of care where patients can receive needed services.
Finding providers who meet the needs of individual patients and with whom patients can develop a relationship based on mutual communication and trust.

6. Health care access is measured in several ways, including:
Structural measures of the presence or absence of specific resources that facilitate health care, such as having health insurance or a usual source of care.
Assessments by patients of how easily they can gain access to health care.
Utilization measures of the ultimate outcome of good access to care (i.e., the successful receipt of needed services).

7. National HealthCare Disparities Report, 2005 - 1
Major issues of disparity occur for poor people and Hispanics, with lesser but important issues for Blacks, American Indians and Asians.
Poor people have worse access to care than high income people for all eight core report measures.

8. National HealthCare Disparities Report, 2005 - 2
Hispanics have worse access for 88 percent of the core report measures, while Blacks and American Indians have worse access on half of the measures.
Asian Americans have worse access on 43 percent of the measures.

9. National Health Disparities Report in 2011
Health insurance facilitates entry into the health care system. Uninsured people are less likely to receive medical care and more likely to have poor health status.
The financial burden of uninsurance is also high for uninsured individuals; almost 50% of personal bankruptcy filings are due to medical expenses

10. National Health Disparities Report 2011 - continued
Race/ehtnicity:
In 2009, Blacks under age 65 were less likely than Whites to have health insurance, and American Indians and Alaska Natives (AI/ANs) under age 65 were less likely than Whites to have health insurance.
In 2009, Hispanics under age 65 were less likely than non-Hispanic Whites to have health insurance.

11. Income and Education
The percentage of people with health insurance was significantly lower for poor, low-income, and middle-income people than for high-income people.
The percentage of people with health insurance was about one-third lower for people with less than a high school education than for people with any college education.

12. Language in Home and Place of Birth - California data in 2009
People who did not speak English well or did not speak English at all were more than 3 times as likely as those who speak English only to be uninsured all year in the past year (36% compared with 10%).
People whose preferred language was Spanish were 3 times as likely as people who preferred English to be uninsured all year in the past year (36% compared with 12%).

13. Language in Home and Place of Birth - California data in 2009 – cont.
People whose preferred language was Korean were more than 4 times as likely as those who preferred English to be uninsured all year in the past year (49% compared with 12%).
In California, people who were not born in the United States were almost 3 times as likely as people who were born in the United States to be uninsured all year in the past year (23% compared with 9%)

14. Specific source of care
Issues of race/ethnicity and education and income on having a specific source of care:
In 2009, the percentage of people with a specific source of ongoing care was lower for Blacks and AI/ANs than Whites, and was significantly lower for Hispanics than for non-Hispanic Whites.
In 2009, the percentage of people with a specific source of ongoing care was significantly lower for poor and low-income people than for high-income people.
In 2009, the percentage of people with a specific source of ongoing care was lower for people with less than a high school education and people with a high school education than for people with any college education.

15. Based on persons responding to the question, ‘‘During the past 12 months was there any time when person needed medical care (dental care, prescription drugs) but did not get it because person could not afford it?
  Medical Care and Dental Care -

16. Medical Care - Could Not Afford Care 1
Race and Ethnicity
1997
2011
Whites
10.8%
13.9%
African Americans
15.4&
American Indian or Alaskan Native
14.5%
16.4%
Asian Americans
6.3%
8.9%
Hispanic
10.5%
15.8%
Non-Hispanic white
10.9%
13.6%

17. Medical Care - Could Not Afford Care - 2
SES (Education and Income)
1997
2011
Education
No HS diploma or GED
16.2%
20.2%
Some college or more
9.2%
12.5%
Income
Below 100 % of Poverty level
14.8%
400 % or more of poverty level
1.7%
3.2%

18. Prescription Drugs - Could Not Afford Care 1
Race and Ethnicity
1997
2011
Whites
5.9%
10.2%
African Americans
9.5%
13.7%
American Indian or Alaskan Native
10.1%
11.0%
Asian Americans
2.8%
5.1%
Hispanic
6.7%
12.5%
Non-Hispanic white
9.7%

19. Prescription Drugs - Could Not Afford Care 2
SES (Education and Income)
1997
2011
Education
No HS diploma or GED
11.5%
18.3%
Some college or more
4.3%
8.8%
Income
Below 100 % of Poverty level
14.8%
20.2%
400 % or more of poverty level
1.7%
3.2%

20. Dental Care - Could Not Afford Care 1
Race and Ethnicity
1997
2011
Whites
10.6%
16.4%
African Americans
10.8%
18.3%
American Indian or Alaskan Native
18.8%
17.2%
Asian Americans
7.8%
9.9%
Hispanic
11.5%
21.1%
Non-Hispanic white
10.5%
15.4%

21. Dental Care - Could Not Afford Care 2
SES (Education and Income)
1997
2011
Education
No HS diploma or GED
14.5%
26.2%
Some college or more
8.8%
14.0%
Income
Below 100 % of Poverty level
19.4%
29.4%
400 % or more of poverty level
4.5%
6.2%

22. Delay in Medical Care by Region
1997
2011
Northeast
8.8%
9.9%
Midwest
10.5%
13.7%
South
11.8%
15.3%
West
10.8%