Health - Health Care

Quality of Care

The 2004 National Healthcare Disparities Report (December 2004, http://www.qualitytools.ahrq.gov/disparitiesreport/2004/documents/nhdr2004.pdf), which is published by the U.S. Department of Health and Human Services, defines quality health care as "doing the right thing, at the right time, in the right way, for the right people—and having the best possible results." Quality health care is defined as care that is effective, safe, and timely, as well as equitable—meaning that the care does not vary in quality because of personal characteristics such as race or ethnicity.

The report focused on forty-six measures of effectiveness of health care and found that minorities consistently received a poorer quality of care than non-Hispanic whites in 2001. In fact, that difference in quality of care had actually worsened for African-Americans, Asian-Americans, and Native Americans and Alaska Natives since the previous year. African-Americans received poorer quality of care than whites for about 63% of the quality measures, Native Americans and Alaska Natives for about 32% of quality measures, and Asian-Americans for about 12% of the quality measures. (See Figure 6.2.) Hispanics received lower quality of care than non-Hispanic whites for about 50% of the quality measures.

Access to Care

The 2004 National Healthcare Disparities Report also measures access to health care, finding that minorities, particularly those of low socioeconomic status, face barriers to access health care that make receiving basic health services a struggle. Access is measured in FIGURE 6.1 Population by Hispanic origin and age group, 2002 Roberto R. Ramirez and G. Patricia de la Cruz, "Figure 3. on by Hispanic Origin and Age Group: 2002," in The Hispanic on in the United States: March 2002, Current Population P20-545, U.S. Census Bureau, June 2003, http://www.census.gov/prod/2003pubs/p20-545.pdf (accessed December 9, 2005)several ways, including ability to get into the health care system, to get care within the health care system, and to find providers to meet their needs.

The report finds that in 2001 Native Americans and Alaska Natives had worse access to care than did whites for about half of access measures, African-Americans for about 34% of access measures, and Asian-Americans for about 31% of access measures. (See Figure 6.2.) Hispanics had worse access to care than non-Hispanic whites for a staggering 88% of access measures. (See Figure 6.3.) Part of these differences in access to care for minority groups had to do with socioeconomics; people below the poverty level had worse access to care than did high-income people (family incomes above 400% of the poverty level) for about 80% of access measures.

HEALTH INSURANCE

Lack of health insurance is one formidable barrier to receiving health care. The number of uninsured Americans rose to its highest level ever in 2004, when 45.8 million people were uninsured. Lack of insurance coverage is a significant barrier to getting basic health care services. The 2004 National Healthcare Disparities Report emphasizes that uninsured people are more likely to die early and to have a poor health status because it is more difficult for the uninsured to get health care and therefore they are diagnosed at later disease stages.

Between 2002 and 2004 members of minority groups were much less likely to carry health insurance coverage than were their white, non-Hispanic counterparts. On average during that period 32.6% of Hispanics, 29% of Native Americans and Alaska Natives, 21.8% of Native Hawaiians and Other Pacific Islanders, 19.8% of African-Americans, and 18% of Asian-Americans lacked coverage, compared with only 11% of non-Hispanic whites. (See Table 6.1.)

Those minorities who do have health insurance are more likely than non-Hispanic whites to be covered by government programs. In 2003 members of all minority groups except Asian-Americans were more likely to be covered by Medicaid (the federally funded health care program for low-income people) than were non-Hispanic whites. In that year Medicaid covered 8% of non-Hispanic whites and Asian-Americans. However, Medicaid covered 23.4% of non-Hispanic African-Americans, 21.8% of Hispanics, and 18.5% of Native Americans and Alaska Natives. Among Hispanics, Puerto Ricans were most likely and Cubans were least likely to be covered by Medicaid. The large proportion of minorities on Medicaid is in part explained by eligibility requirements; only poor and low-income people qualify, and members of these groups are disproportionately poor. (See Table 6.2.)

Nearly all people age sixty-five and older are covered by health insurance due largely to Medicare (the government health insurance program for senior citizens). However, a much higher proportion of minorities are additionally covered by Medicaid, while non-Hispanic whites are covered by private insurance. In 2003, 65.7% of non-Hispanic whites age sixty-five and over were covered by private health insurance; in contrast, only 40.2% of Asian-Americans, 37.6% of African-Americans, 37.3% of Native Americans and Alaska Natives, and 24% of Hispanics of the same age were covered by private insurance. (See Table 6.3.)

DOCTOR VISITS

Another measure of a group's access to care is the number of doctor visits. Since the 1980s, as more outpatient clinics and other outreach health facilities have opened, Americans have had increased opportunities to seek medical help; however, in 2003 members of minority groups were more likely than non-Hispanic whites to have made no visits to a doctor's office or emergency room in the previous twelve months. In that year, 25.3% of Hispanics, 23.3% of Native Americans and Alaska Natives, 22.6% of Asian-Americans, and 14.6% of African-Americans made no visits, compared with 13.5% of non-Hispanic whites who made no visits. (See Table 6.4.) In part, this can be explained by the disproportionate number of minorities who are poor or low income; these groups were more likely than nonpoor people to make no visits to a doctor's office or an emergency room in 2003.

INDIAN HEALTH SERVICE

Federal funding for Native American health care is provided through the Indian FIGURE 6.2 Percent of measures for which members of selected racial groups experience poorer quality of care or have worse access to care compared with whites, 2000 and 2001 "Figure H.1. Percent of Measures for Which Members of Selected Racial Groups Experience Poorer Quality of Care (Left) or Have Worse Access to Care (Right) Compared with Whites in 2000 and 2001," in 2004 National Healthcare Disparities Report, U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, December 2004, http://qualitytools.ahrq.gov/disparitiesreport/documents/nhdr2004.pdf (accessed January 25, 2006)Health Service (IHS), which is "charged with raising Indians' health status to the highest possible level" (April 1993, http://archive.gao.gov/t2pbat6/149156.pdf). Delivery of health care to Native Americans is complicated by the lack of services and the long distances that sometimes must be traveled to receive care. Alaska Natives are often able to get preventive medical care only by flying to a medical facility, and, while transportation costs are covered for emergency care, transportation costs are not provided for routine care. The 2004 National Healthcare Disparities Report reports that nationwide about 60% of Native Americans rely on the Indian Health Service to provide access to health care.

Many Native American tribes have invested some of the money earned from their casinos to improve health services. The Sandia Pueblo in New Mexico, for example, now has a multimillion-dollar medical complex. This saves the residents the long drives to distant clinics that provide medical and dental care through the IHS. The center includes examination rooms, dental rooms, and state-of-the-art equipment. There is an adjacent wellness and education center that houses a gymnasium, a weight room, and aquatic therapy facilities.