Inequality in care access is getting worse

Race-based disparities in access to timely health care are growing more acute, a new study finds, and for reasons not directly related to the costs of care or health insurance coverage.

The study’s authors analyzed trends in non-financial barriers to care access from 1999 to 2018 among 590,000 individuals who identified as Black, Asian, Hispanic/Latino or White. The barriers they examined included:

• inability to contact a provider by telephone,
• appointments not being available soon enough,
• long wait times at an office or clinic,
• inconvenient office or clinic hours, and
• lack of transportation.

Data for the study came from the National Health Interview Survey.

The researchers found that the overall prevalence of barriers to timely care increased from 7.1% in 1999 to 13.5% in 2018, but the increase was unevenly distributed by race and ethnicity. Asians and Whites experienced prevalence increases of 5.74% and 5.85%, respectively, compared with 7.95% for Blacks and 8.0% for Hispanics/Latinos.

Similar differences were apparent in reports of specific barriers to timely care. For example, the number of Whites saying they delayed care due to long wait times increased by 1.23%. For Asians the increase was 2.60%, for Blacks 2.73% and for Hispanics/Latinos it was 3.86%. And the number of Asians citing lack of transportation as a barrier grew by 0.38%, compared with 0.92% for Whites, 1.01% for Hispanics/Latinos, and 2.73% for Blacks.

The authors note that while their study focuses on barriers separate from insurance coverage and care affordability, “the complexity of the US health care system makes it implausible to isolate these [barriers] from an individual’s health insurance status and overall financial situation.”

The authors say, their findings point to “a worsening societal failure to deliver timely medical care,” and that “attempts to improve access to care through improving access to insurance coverage alone [through the Affordable Care Act] may be inadequate—and may not be enough to reduce racial disparities.”

Instead, they say, efforts to reduce disparities in care access requires broader societal reforms in areas such as education, housing, urban planning and transportation. Moreover, the historical segregation of Blacks and Latinos means they are more likely to live in medically underserved areas, causing them to visit emergency departments for primary care-treatable conditions, creating a need for “a multisectoral effort to improve spatial accessibility to high-quality primary care clinics and health care professional for minoritized race and ethnicity groups.”

The study, “Trends in Racial and Ethnic Disparities in Barriers to Timely Medical Care Among Adults in the US, 1999-2018” was published online October 28 in JAMA Health Forum.