Minorities More Likely Than Whites To Report Difficulty Communicating with Care Providers, Face Other Barriers, Survey Says

Minority Americans do not fare as well as whites on almost every measure of health care quality, according to a new Commonwealth Fund survey. Researchers conducted telephone interviews from April to November 2001 with 6,722 adults ages 18 and over, including 3,488 whites, 1,153 Hispanics, 1,037 African Americans and 669 Asian Americans. The study found that while differences exist between various minority groups, African Americans, Asian Americans and Hispanics are all more likely than whites to "experience difficulty communicating with their physician, to feel that they are treated with disrespect when receiving health care, to experience barriers to access to care such as lack of insurance or not having a regular doctor and to feel they would receive better care if they were of a different race or ethnicity." Below are some key findings from the survey:

• Coverage: The survey found that Hispanic and African Americans were most likely to be uninsured, as 46% and 33% of working-age Hispanics and African Americans, respectively, lacked insurance for all or part of the 12 months prior to the survey. In comparison, one-fifth of both whites and Asian Americans ages 18-64 lacked health coverage for all or part of the previous 12 months. In addition, 39% of uninsured Hispanics, 38% of uninsured African Americans and 32% of uninsured Asian Americans said they had "little or no choice in their source of health care," compared to 25% of uninsured whites. Minority adults, whether they had insurance or not, were also less likely to have a regular doctor.
• Outcomes: Minority adults were more likely to have health problems than whites. Twenty-two percent of Hispanics, 17% of African Americans and 17% of Asians scored their health as fair or poor, compared with 14% of whites -- a result "even more striking when taking into account the minority population is on average younger than the white population, and would therefore be expected to be healthier."
• Communication: Thirty-three percent, 27%, and 23% of Hispanics, Asian Americans and African Americans, respectively, reported at least one communication problem with their doctor, compared to 16% of whites. Forty-five percent of Hispanics reported that it was "very easy to understand" information from their doctor, compared to 59% of whites. This disparity was magnified among Asian Americans and Hispanics who did not speak English; 43% of Hispanics who primarily speak Spanish reported communication problems with their physicians, compared to 26% of Hispanics who primarily speak English. The rates for Asians were 39% and 25%, respectively.
• Satisfaction: Sixty-five percent of whites and 61% of African Americans said they were "very satisfied" with their health care, compared to 56% of Hispanics and 45% of Asian Americans. In addition, whites and African Americans also were more likely to receive preventive care than Hispanics and Asian Americans. However, African Americans' health outcomes still remained worse than whites despite similar rates of preventive care -- a disparity that will require "close examination of other points of health care delivery where problems may be occurring, such as in access to specialized care or patients' ability to carry out instructions at home," according to the report (Commonwealth Fund release, 3/6).

Solutions
The report, noting that efforts at the state and federal level are already underway to eliminate racial disparities in health care, says that public policy can go further toward reaching this goal. The study says that reducing the number of uninsured is the most important step in improving care for minorities, adding that the survey results "could help guide insurance coverage policies that are sensitive to the diverse needs of the minority populations." The report recommends that the government support efforts to give providers training in serving diverse cultures and help medical schools develop programs to "determine the most effective strategies for improving patient outcomes." Further, the report urges greater preventive care for Hispanics and Asian Americans (Collins et al., "Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans," March 2002). "For almost every measure of quality there is a sharp division between the health care experiences of white and minority Americans," Commonwealth President Karen Davis said, adding, "As our population grows more diverse, these findings send a clear warning that the health care quality divide is in danger of turning into a gulf" (AP/Las Vegas Sun, 3/6).

Additional Resources
The full survey is available online. Fact sheets for African Americans, Asian Americans and Hispanics also are available online. Note: You will need Adobe Acrobat Reader to view the survey and the fact sheets. In addition, a HealthCast of the conference unveiling the survey is available online.