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Racial and ethnic disparities loom large in barriers to timely medical care

Researchers find that black and Latino adults face greater barriers to timely medical care than white adults.

Barriers to timely medical care based on racial and ethnic disparities have increased over the past two decades, according to a recent research paper.

Racial and ethnic disparities impact access to health care. Previous research showed that blacks and Latinos had a lack of health insurance and higher cost-related unmet medical needs than whites from 1999 to 2018.

The recent research paper, which was published by JAMA Health Forumis based on data collected from more than 590,000 adults across the National Health Interview Survey from 1999 to 2018. Researchers looked at trends in five barriers to timely medical care: inability to get an appointment over the phone, no appointment available early enough, long wait times, office hours or inconvenient clinic and lack of transport.

The study has several key data points:

  • In 1999, the percentage of people reporting one of five barriers to timely medical care was 7.3% in the Asian group, 6.9% in the Black group, 7.9% in the Hispanic group and Latino and 7.0% in the white group.
  • From 1999 to 2018, the percentage of adults reporting one of five barriers to timely medical care increased for all four racial and ethnic groups, increasing by 5.7 percentage points for Asians, 8.0 points for percentage for blacks, 8.1 percentage points for Hispanics and Latinos, and 5.9 percentage points for whites
  • In 2018, compared to white adults, the proportion of adults reporting a barrier was 2.1 percentage points higher for black adults and 3.1 percentage points higher for Hispanic and Latino adults
  • From 1999 to 2018, compared to white adults, black adults experienced a 1.5 percentage point higher delay in care due to long wait times at a clinic or doctor’s office, as well as a delay 1.8 percentage points higher care due to lack of transportation.
  • From 1999 to 2018, compared to white adults, Hispanic and Latino adults experienced a 2.6 percentage point higher delay in care due to long wait times
  • In 2018, the overall proportion of adults reporting a barrier was 13.5%, with the adjusted prevalence among white adults being 12.9% and the proportion 2.1 percentage points higher among black adults and 3.1 percentage points higher among Hispanic and Latino adults.
  • From 1999 to 2018, compared to uninsured white adults, disparities in any barrier to timely medical care increased by 6.6 percentage points for uninsured black adults and 5.3 percentage points for adults Hispanics and Latinos
  • In 2018, compared to white adults, the proportion of Hispanic and Latino adults who experienced a delay in care due to long wait times was 4.0 percentage points higher
  • In 2018, compared to white adults, the proportion of Hispanic and Latino adults who experienced a delay in care due to lack of transportation was 1.0 percentage points higher

“The results of this serial cross-sectional study of National Health Interview Survey data suggest that barriers to timely medical care in the United States increased for all population groups from 1999 to 2018, with associated increases in disparities between racial and ethnic groups.Interventions beyond those currently being implemented are needed to improve access to medical care and eliminate disparities between racial and ethnic groups,” the study co-authors wrote.

Interpret the data

Over the study period, barriers to timely care increased significantly, with a disparity gap between white adults and black and Latino adults, the study co-authors wrote. “In this nationally representative study, we found that between 1999 and 2018, the overall estimated proportion of respondents who reported barriers to timely care nearly doubled, from 7.1% to 13, 5%, and the increase was not proportional across the four races and ethnicities.During this period, the differences in accessibility and availability of care between white respondents and black and Latino respondents increased.In 2018 , black and Latino respondents were more likely to report delayed care due to lack of transportation and long wait times at the doctor’s office compared to white respondents.”

The data has three implications for health policy, the study co-authors wrote:

  • “The increasing prevalence of barriers between racial and ethnic groups in the United States indicates a worsening of society’s failure to provide timely medical care. The fact that, overall, nearly 1 in 7 adults in 2018 experienced barriers to timely medical care indicates that attempts to improve access to care by improving access to insurance coverage alone may be insufficient and may not be sufficient to reduce disparities…. Although increasing insurance coverage may address unmet medical needs by reducing costs, it is less clear that it removes barriers to timely medical care that are not directly related to cost.”
  • “Growing racial and ethnic disparities in the prevalence of these barriers to timely medical care suggest that the scope of national efforts to eliminate disparities in access to health care should be broadened to include societal reforms beyond health care system This does not imply that specific health care interventions (e.g., [Affordable Care Act]culturally and linguistically appropriate national services) are not fundamental to achieving this goal, but that eliminating disparities in these indicators requires that policy interventions address non-medical barriers to access and quality of health care. health, including education, housing, urban planning, employment and transportation, which disproportionately affect underserved populations.”
  • “There are important implications from the results stratified on income and gender. The finding that racial and ethnic disparities were mitigated by lower income serves as an example of the pervasiveness of income inequality in access to health care, even beyond cost-related indicators With respect to gender, although racial and ethnic disparities among women were mostly static, they had a higher overall prevalence of barriers over the study period compared to men of the same race or ethnicity, pregnancy, menopause, gender-sensitive care), these findings add to the evidence for the need for improved women’s access to primary care throughout the different stages of the life cycle.

Christopher Cheney is the Clinical Care Editor at HealthLeaders.

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