Understanding Racial and Ethnic Differences in Health in Late Life A Research Agenda (2004) / Chapter Skim
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10 Health Care
10 Health Care
Pages 92-103
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From page 92... ...
Why this is so, however, is a complex issue involving not only possible differences in ability to pay and provider behavior, but also in such factors as patient preferences, differential treatment by providers, and geographical variability. INSURANCE COVERAGE Blacks, Hispanics, and some Asian populations, when compared with whites, appear to have lower levels of health insurance coverage, with Hispanics facing greater barriers to health insurance than any other group (Institute of Medicine, 2002)
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From page 93... ...
. Moreover, this study found that, even if income and health insurance coverage were equal, racial and ethnic differences in having a usual source of care and in receiving ambulatory care in the previous year would not have been eliminated, because one-half to three-quarters of the differences on these indicators were not accounted for by income and insurance coverage.
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From page 94... ...
. Not surprisingly, although black Medicare beneficiaries report higher levels of morbidity than their white counterparts, they report lower levels of office visits and more inpatient, emergency room, and nursing home visits (Gornick, 2000)
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From page 95... ...
The tripartite system of the IHS, tribally operated clinics, and urban Indian clinics represent a unique ecology within which American Indians seek help for physical, mental, alcohol, and drug problems. This is particularly relevant when discussing health care challenges for American Indian elderly since the emphasis of the IHS system is on acute rather than chronic health problems (Baldridge, 2001)
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From page 96... ...
96 t. treatmen ican 15 Medicaid)
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From page 97... ...
Such differences in the receipt of medical procedures are consistent with a larger literature, generally for earlier years, that finds systematic racial and ethnic differences in the receipt of a broad spectrum of therapeutic interventions (Geiger, 2002; Institute of Medicine, 2002; Mayberry et al., 2000)
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From page 98... ...
Some geographic variation may be due to racial factors related to residential segregation by race. But some variation in care is clearly not geographic, as when variations exist within geographic areas.
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From page 99... ...
Within groups of hospitals with different proportions of black admissions, however, white patients actually received poorer care than blacks, as reflected in 30-day mortality rates adjusted for various factors. STEREOTYPING BY PROVIDERS Some differences in medical care may be due to stereotypes of different groups held by health care providers.
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From page 100... ...
found that -- even after adjusting for patient age, sex, socioeconomic status, sickness or frailty and overall health, and patient availability of social support -- physicians viewed black patients, compared with whites, as less kind, congenial, intelligent, and educated, less likely to adhere to medical advice, and more likely to lack social support and to abuse alcohol and drugs. Experimental studies of physicians (Schulman et al., 1999; Weisse et al., 2001)
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From page 101... ...
For instance, persistence with statin therapy among older patients -- which tends to decline over time and is also related to socioeconomic status -- declines more, regardless of status, among blacks and other nonwhite patients than in white patients. In fact, black subjects had 2.7 times the odds of suboptimal persistence with statin therapy compared with whites, the racial difference being greater than that on any other predictor analyzed (Benner et al., 2002)
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From page 102... ...
. What this effect could be, what differences actually exist beyond those now documented, how they interact with multiple vulnerabilities in the older population, and how health care should be properly structured to address differences are all issues that require attention.
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From page 103... ...
Health Care Institutions The specific characteristics of health care institutions and systems that affect racial and ethnic differences in care require attention. Financial, structural, and institutional factors need consideration, taking into account features of medical procedures, such as their cost, and the degree to which medical consensus exists about particular treatments.
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