Agency for Healthcare Research and QualityAdvancing Excellence in Health Care www.ahrq.gov
CHARTBOOK ON ACCESS TOHEALTH CARE
National Healthcare Quality and Disparities Report
This document is in the public domain and may be used and reprinted without permission.
Citation of the source is appreciated. Suggested citation: National Healthcare Quality and
Disparities Report chartbook on access to health care. Rockville, MD: Agency for Healthcare
Research and Quality; May 2016. AHRQ Pub. No. 16-0015-5-EF.
NATIONAL HEALTHCARE QUALITY AND DISPARITIES REPORT CHARTBOOK ON ACCESS TO HEALTH CARE
U.S. DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
5600 Fishers Lane
Rockville, MD 20857
AHRQ Publication No. 16-0015-5-EF
May 2016
www.ahrq.gov/research/findings/nhqrdr/index.html
ACKNOWLEDGMENTS
The National Healthcare Quality and Disparities Report (QDR) and the National Quality Strategy (NQS) report are
the products of collaboration among agencies from the U.S. Department of Health and Human Services (HHS),
other Federal departments, and the private sector. Many individuals guided and contributed to this effort. Without
their magnanimous support, the reports would not have been possible.
Specifically, we thank:
Authors: Irim Azam (Lead Author-AHRQ), Ernest Moy (AHRQ).
Primary AHRQ Staff: Andrew Bindman, Sharon Arnold, Jeff Brady, Amy Helwig, Ernest Moy, Nancy Wilson,
Darryl Gray, Barbara Barton, and Doreen Bonnett.
HHS Interagency Workgroup for the QDR: Girma Alemu (HRSA), Chisara N. Asomugha (CMS), Kirsten
Beronio (ASPE), Nancy Breen (NCI), Miya Cain (ACF), Victoria Cargill (NIH), Steven Clauser (NCI), Wayne
Duffus (CDC), Olinda Gonzalez (SAMHSA), Kirk Greenway (IHS), Chris Haffer (CMS-OMH) , Linda Harlan
(NCI), Edwin Huff (CMS), Deloris Hunter (NIH), Sonja Hutchins (CDC), Ruth Katz (ASPE), Tanya Telfair
LeBlanc (CDC), Shari Ling (CMS), Darlene Marcoe (ACF), Tracy Matthews (HRSA), Karen McDonnell (CMS),
Curt Mueller (HRSA), Karen Nakano (CMS), Iran Naqvi (HRSA), Ann Page (ASPE), Kimberly Proctor (CMS-
OMH), D.E.B Potter (ASPE), Asel Ryskulova (CDC-NCHS), Adelle Simmons (ASPE), Alan Simon (CDC-NCHS),
Marsha Smith (CMS), Caroline Taplin (ASPE), Emmanuel Taylor (NCI), Sayeedha Uddin (CDC-NCHS),
Nadarajen Vydelingum (NIH), Chastity Walker (CDC), Barbara Wells (NHLBI), Valerie Welsh (OASH-OMH), Tia
Zeno (ASPE), and Ying Zhang (IHS).
QDR/NQS Team: Irim Azam (CQuIPS), Barbara Barton (CQuIPS), Doreen Bonnett (OCKT), Cecilia Casale
(OEREP), Frances Chevarley (CFACT), Noel Eldridge (CQuIPS), Coral Ellis (BAH), Camille Fabiyi (OEREP),
Zhengyi Fang (SSS), Ann Gordon (BAH), Erin Grace (CQuIPS), Darryl Gray (CQuIPS), Kevin Heslin (CDOM),
Anil Koninty (SSS), Emily Mamula (BAH), Kamila Mistry (OEREP), Atlang Mompe (SSS), Ernest Moy (CQuIPS),
Heather Plochman (BAH), Susan Raetzman (Truven), Michelle Roberts (CFACT), Lily Trofimovich (SSS), Yi
Wang (SSS), and Nancy Wilson (CQuIPS).
HHS Data Experts: Clarice Brown (CDC-NCHS), Anjani Chandra (CDC-NCHS), Laura Cheever (HRSA),
Frances Chevarley (AHRQ), Robin Cohen (CDC-NCHS), Rupali Doshi (HRSA), John Fleishman (AHRQ),
Elizabeth Goldstein (CMS), Selena Gonzalez (CDC-HIV), Beth Han (SAMHSA), Haylea Hannah (CDC) ,
Kimberly Lochner (CMS), Marlene Matosky (HRSA), (HRSA),William Mosher (CDC-NCHS), Richard Moser
(NCI), Cynthia Ogden (CDC-NCHS), Robert Pratt (CDC), Asel Ryskulova (CDC-NCHS), Alan Simon (CDC-
NCHS), Alek Sripipatana (HRSA), Reda Wilson (CDC/ONDIEH/NCCDPHP), Richard Wolitski (CDC-HIV), and
Xiaohong (Julia) Zhu.
Other Data Experts: Dana Auden (Oklahoma Foundation for Medical Quality [OFMQ]), Sarah Bell (University of
Michigan), Mark Cohen (ACS NSQIP), Timothy Chrusciel (OFMQ), Sheila Eckenrode (MPSMS-Qualdigm),
Melissa Fava (University of Michigan), David Grant (UCLA), Michael Halpern (American Cancer Society),
Matthew Haskins (NHPCO), Clifford Ko (ACS NSQIP), Allen Ma (OFMQ), Wato Nsa (OFMQ), Nicholas
Okpokho (OFMQ),.Robin Padilla (University of Michigan), Bryan Palis (NCBD, American College of Surgeons),
Pennsylvania Patient Safety Authority, Royce Park (UCLA), William Ross (Fu Associates), Scott Stewart (OFMQ),
VA National Center for Patient Safety (NCPS), Claudia Wright (Oklahoma QIO), and Yolanta Vucic (OFMQ).
Other AHRQ Contributors: Cindy Brach, Biff LeVee, Iris Mabry-Hernandez, Edwin Lomotan, Karen Migdail,
Shyam Misra, Pamela Owens, Mamatha Pancholi, Larry Patton, Wendy Perry, Richard Ricciardi, Mary Rolston, and
Randie Siegel.
Data Support Contractors: Booz Allen Hamilton (BAH), Fu Associates, Social & Scientific Systems (SSS),
Truven Health Analytics, and Westat.
National Healthcare Quality and Disparities Report | 1
ACCESS TO HEALTH CARE
Background
This Chartbook on Access to Health Care is part of a family of documents and tools that support
the National Healthcare Quality and Disparities Report (QDR). The QDR includes annual reports
to Congress mandated in the Healthcare Research and Quality Act of 1999 (P.L. 106-129). These
reports provide a comprehensive overview of the quality of health care received by the general
U.S. population and disparities in care experienced by different racial, ethnic, and socioeconomic
groups. The purpose of the reports is to assess the performance of our health system and to
identify areas of strengths and weaknesses in the health care system along three main axes:
access to health care, quality of health care, and priorities of the National Quality Strategy.
The reports are based on more than 250 measures of quality and disparities covering a broad
array of health care services and settings. Data are generally available through 2013, although
rates of uninsurance have been tracked through the September 2015. The reports are produced
with the help of an Interagency Work Group led by the Agency for Healthcare Research and
Quality (AHRQ) and submitted on behalf of the Secretary of Health and Human Services (HHS).
Chartbook Contents
This chartbook includes:
Summary of disparities across measures of access to health care from the QDR.
Figures illustrating select measures of access.
Introduction and Methods contains information about methods used in the chartbook. A Data
Query tool (http://nhqrnet.ahrq.gov/inhqrdr/data/query) provides access to all data tables.
Access to Health Care
2 | National Healthcare Quality and Disparities Report
Disparities in Access to Care
Note: Poor indicates family income less than the Federal poverty level; High Income indicates family income four
times the Federal poverty level or greater. Numbers of measures differ across groups because of sample size limitations. For most measures, data from 2013 are shown. The relative difference between a selected group and its reference group is used to assess disparities.
• Better = Selected group had better access to care than reference group. Differences are statistically
significant, are equal to or larger than 10%, and favor the selected group.
• Same = Selected group and reference group had about the same access to care. Differences are not
statistically significant or are smaller than 10%.
• Worse = Selected group had worse access to care than reference group. Differences are statistically
significant, are equal to or larger than 10%, and favor the reference group.
Groups With Disparities:
■ People in poor households had worse access to care than people in high-income
households on all access measures (green).
■ Hispanics had worse access to care than Whites for more than two-thirds of access
measures.
■ Blacks had worse access to care than Whites for about half of access measures.
■ Asians had worse access to care than Whites for about one-third of access measures, and
American Indians and Alaska Natives had worse access to care than Whites for about
one-quarter of access measures.
Number and percentage of access measures for which members of selected groups experienced better, same, or worse access to care compared with reference group
35
3 10
811
21
1412
74
0%
20%
40%
60%
80%
100%
Poor vs. HighIncome (n=21)
Hispanic vs.White (n=20)
Black vs. White(n=22)
Asian vs. White(n=20)
AI/AN vs. White(n=15)
Better Same Worse
Key: AI/AN = American Indian or Alaska Native; n = number of measures.
Number and percentage of access measures for which members of selected groups experienced better, same, or worse access to care compared with reference group
35
3 10
811
21
1412
74
0%
20%
40%
60%
80%
100%
Poor vs. HighIncome (n=21)
Hispanic vs.White (n=20)
Black vs. White(n=22)
Asian vs. White(n=20)
AI/AN vs. White(n=15)
Better Same Worse
Key: AI/AN = American Indian or Alaska Native; n = number of measures.
Access to Health Care
National Healthcare Quality and Disparities Report | 3
Elements of Access to Health Care
Access to health care means having “the timely use of personal health services to achieve the
best health outcomes” (IOM, 1993).
Access to health care consists of four components (Healthy People 2020):
■ Coverage: facilitates entry into the health care system. Uninsured people are less likely to
receive medical care and more likely to have poor health status.
■ Services: Having a usual source of care is associated with adults receiving recommended
screening and prevention services.
■ Timeliness: ability to provide health care when the need is recognized.
■ Workforce: capable, qualified, culturally competent providers.
Coverage
Health insurance facilitates entry into the health care system.
■ Uninsured people are less likely to receive medical care and more likely to have poor
health status (Healthy People 2020).
■ Many people rely on public health insurance, such as Medicaid.
♦ Public health insurance also includes Children’s Health Insurance Program (CHIP),
State-sponsored or other government-sponsored health plans, Medicare, and military
plans.
♦ For access measures in this chartbook, a small number of people were covered by
both public and private plans and were included in both categories.
Measures of Coverage
People under age 65 without health insurance coverage at the time of interview by:
■ Age.
■ Race/ethnicity.
■ Poverty status.
Access to Health Care
4 | National Healthcare Quality and Disparities Report
Uninsurance, by Age
Trends:
■ From January 2010 to September 2015, the percentage of people under age 65 who were
uninsured at the time of interview decreased from 17.5% to 10.8%.
■ The percentage of people who were uninsured at the time of interview decreased for all
age groups under age 65. Adults ages 18-29 experienced the largest declines.
People under age 65 who were uninsured at the time of interview,by age, 2010-2015 Q3
0
5
10
15
20
25
30
35
Pe
rce
nt
Total 0-17 18-29 30-64
Key: Q = quarter.
Source: National Center for Health Statistics, National Health Interview Survey, January 2010-September 2015.
Note: For this measure, lower rates are better. Data available for 2015 quarters 1-3 only. Quarter 3 data were made available after the release
of the 2015 National Healthcare Quality and Disparities Report and 5th Anniversary Update on the National Quality Strategy.
October 2013: Affordable Care ActMarketplace Enrollment Begins
People under age 65 who were uninsured at the time of interview, by age, 2010-2015 Q3
0
5
10
15
20
25
30
35
Pe
rce
nt
Total 0-17 18-29 30-64
Key: Q = quarter.
Source: National Center for Health Statistics, National Health Interview Survey, January 2010-September 2015.
Note: For this measure, lower rates are better. Data available for 2015 quarters 1-3 only. Quarter 3 data were made available after the release
of the 2015 National Healthcare Quality and Disparities Report and 5th Anniversary Update on the National Quality Strategy.
October 2013: Affordable Care Act Marketplace Enrollment Begins
Access to Health Care
National Healthcare Quality and Disparities Report | 5
Uninsurance, by Race/Ethnicity
Trends: From January 2010 to September 2015, the percentage of people under age 65 who
were uninsured at the time of interview decreased for all racial/ethnic groups.
Groups With Disparities:
■ In all quarters, Blacks and Hispanics were more likely to be uninsured than Whites.
■ Gaps related to race/ethnicity were getting smaller over time.
People under age 65 who were uninsured at the time of interview, by race/ethnicity, 2010-2015 Q3
0
10
20
30
40
50
Pe
rce
nt
White Black Hispanic
October 2013: Affordable Care Act
Marketplace Enrollment Begins
Key: Q = quarter.
Source: National Center for Health Statistics, National Health Interview Survey, January 2010-September 2015.
Note: For this measure, lower rates are better. Data available for 2015 quarters 1-3 only. White and Black are non-Hispanic. Hispanic includes
all races.
People under age 65 who were uninsured at the time of interview, by race/ethnicity, 2010-2015 Q3
0
10
20
30
40
50
Pe
rce
nt
White Black Hispanic
October 2013: Affordable Care Act
Marketplace Enrollment Begins
Key: Q = quarter.
Source: National Center for Health Statistics, National Health Interview Survey, January 2010-September 2015.
Note: For this measure, lower rates are better. Data available for 2015 quarters 1-3 only. White and Black are non-Hispanic. Hispanic includes
all races.
Access to Health Care
6 | National Healthcare Quality and Disparities Report
Uninsurance, by Poverty Status
Trends: From January 2010 to June 2015, the percentage of people under age 65 who were
uninsured at the time of interview decreased for all poverty status groups.
Groups With Disparities:
■ In all quarters, people in poor and near-poor households were more likely to be uninsured
than people in households that were not poor.
■ Gaps in rates of uninsurance between people who were poor and those who were not poor
and between people who were near poor and those who were not poor were getting
smaller over time.
Services
People with a usual source of care have better health outcomes, fewer disparities, and lower
costs (Healthy People 2020).
People with a usual place of care and a usual provider are more likely to receive preventive
services and recommended screenings than people with no usual source of care (Blewett, et
al., 2008).
People under age 65 who were uninsured at the time of interview, by poverty status, 2010-2015 Q3
Key: Q = quarter.
Source: National Center for Health Statistics, National Health Interview Survey, January 2010-September 2015.
Note: For this measure, lower rates are better. Data available for 2015 quarters 1-3 only. Poverty categories are based on the Federal Poverty
Level (FPL). Poor = below the FPL; Near Poor = 100% to <200% of the FPL; Not Poor = 200% or more of the FPL.
0
10
20
30
40
50
Pe
rce
nt
Poor Near Poor Not Poor
October 2013: Affordable Care Act
Marketplace Enrollment Begins
People under age 65 who were uninsured at the time of interview, by poverty status, 2010-2015 Q3
Key: Q = quarter.
Source: National Center for Health Statistics, National Health Interview Survey, January 2010-September 2015.
Note: For this measure, lower rates are better. Data available for 2015 quarters 1-3 only. Poverty categories are based on the Federal Poverty
Level (FPL). Poor = below the FPL; Near Poor = 100% to <200% of the FPL; Not Poor = 200% or more of the FPL.
0
10
20
30
40
50
Pe
rce
nt
Poor Near Poor Not Poor
October 2013: Affordable Care Act
Marketplace Enrollment Begins
Access to Health Care
National Healthcare Quality and Disparities Report | 7
Measures of Services
Age-sex adjusted percentage of people of all ages with a usual place to go for medical care
People who were unable to get or delayed in getting needed medical care, dental care, or
prescription medicines in the last 12 months
People who were unable to get or delayed in getting needed medical care, dental care, or
prescription medicines in the last 12 months
Usual Source of Care
Trends: From January 2010 to September 2015, the percentage of people with a usual place
to go for medical care increased overall, for Blacks, and for Hispanics. There were no
statistically significant changes for Whites.
Groups With Disparities:
■ In all years, Blacks and Hispanics were less likely than Whites to have a usual place to go
for medical care.
■ Gaps related to race/ethnicity were getting smaller over time.
Age-sex adjusted percentage of people of all ages with a usual place to go for medical care, by race/ethnicity, 2010-2015 Q3
50
60
70
80
90
100
2010 2011 2012 2013 2014 2015 Q1-3
Pe
rce
nt
Total White Black Hispanic
Source: National Center for Health Statistics, National Health Interview Survey, January 2010-September 2015.
Note: Total is only age adjusted. For this measure, lower rates are better. Data available for 2015 quarters 1-3 only. An emergency department
is not considered a usual place to go for medical care.
Age-sex adjusted percentage of people of all ages with a usual place to go for medical care, by race/ethnicity, 2010-2015 Q3
50
60
70
80
90
100
2010 2011 2012 2013 2014 2015 Q1-3
Pe
rce
nt
Total White Black Hispanic
Source: National Center for Health Statistics, National Health Interview Survey, January 2010-September 2015.
Note: Total is only age adjusted. For this measure, lower rates are better. Data available for 2015 quarters 1-3 only. An emergency department
is not considered a usual place to go for medical care.
Access to Health Care
8 | National Healthcare Quality and Disparities Report
Difficulty Getting Care, by Insurance and Age
Overall Rate: In 2013, the overall percentage of people unable to get or delayed in getting
needed medical care, dental care, or prescription medicines in the last 12 months was 11.7%.
Trends: From 2002 to 2013, there were no statistically significant changes in the percentage
of people who were unable to get or delayed in getting needed medical care, dental care, or
prescription medicines in the last 12 months for any insurance or age group, except people
ages 0-17. The percentage for that group decreased.
Groups With Disparities:
■ In all years, among people under age 65, the percentage unable to get or delayed in
getting needed medical care, dental care, or prescription medicines was higher for
uninsured people and people with public insurance compared with people with private
insurance. The gap between uninsured people and people with private insurance was
growing larger over time.
■ In all years, the percentage of people unable to get or delayed in getting needed medical
care, dental care, or prescription medicines was higher for adults ages 18-44 than for
children ages 0-17. The gap between adults ages 45-64 and adults ages 18-44 was
growing larger over time, as was the gap between adults ages 45-64 and adults age 65
and over.
People who were unable to get or delayed in getting needed medical care,dental care, or prescription medicines in the last 12 months, by insurance
(under age 65) and age, 2002-2013
0
5
10
15
20
25
Pe
rce
nt
Total Private Public Uninsured
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2013.
Note: For this measure, lower rates are better.
0
5
10
15
20
25
Pe
rce
nt
0-17 18-44 45-64 65+
People who were unable to get or delayed in getting needed medical care, dental care, or prescription medicines in the last 12 months, by insurance
(under age 65) and age, 2002-2013
0
5
10
15
20
25
Pe
rce
nt
Total Private Public Uninsured
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2013.
Note: For this measure, lower rates are better.
0
5
10
15
20
25
Pe
rce
nt
0-17 18-44 45-64 65+
Access to Health Care
National Healthcare Quality and Disparities Report | 9
Difficulty Getting Care, by Health Status and Ethnicity
Trends:
■ From 2002 to 2013, there were no statistically significant changes among people with
fair/poor or excellent/very good/good perceived health status in the percentage of people
who were unable to get or delayed in getting needed medical care, dental care, or
prescription medicines.
■ From 2002 to 2013, there were no statistically significant changes among Whites or
Blacks in the percentage of people who were unable to get or delayed in getting needed
medical care, dental care, or prescription medicines.
■ From 2003 to 2013, the percentage of people who were unable to get or delayed in
getting needed medical care, dental care, or prescription medicines improved for
Hispanics.
People who were unable to get or delayed in getting needed medical care,dental care, or prescription medicines in the last 12 months, by perceived
health status and ethnicity, 2003-2013
0
5
10
15
20
25
30
35
Pe
rce
nt
Excellent/Very Good/Good Fair/Poor
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2003-2013.
Note: For this measure, lower rates are better. White and Black are non-Hispanic. Hispanic includes all races.
0
5
10
15
20
25
30
35
Pe
rce
nt
White Black Hispanic
People who were unable to get or delayed in getting needed medical care, dental care, or prescription medicines in the last 12 months, by perceived
health status and ethnicity, 2003-2013
0
5
10
15
20
25
30
35
Pe
rce
nt
Excellent/Very Good/Good Fair/Poor
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2003-2013.
Note: For this measure, lower rates are better. White and Black are non-Hispanic. Hispanic includes all races.
0
5
10
15
20
25
30
35
Pe
rce
nt
White Black Hispanic
Access to Health Care
10 | National Healthcare Quality and Disparities Report
Groups With Disparities:
In 2013, there was no statistically significant change in the gap between people who ■perceived their health status to be fair or poor and people who perceived their health
status to be excellent, very good, or good.
■ In 2013, Hispanics were less likely than Whites to have difficulty getting needed medical
care, dental care, or prescription medicines.
Timeliness
Timeliness in health care is the system’s capacity to provide care quickly after a need is
recognized. (Healthy People 2020).
Timely delivery of appropriate care can help reduce mortality and morbidity for chronic
conditions, such as kidney disease (Smart & Titus, 2011).
Measures of Timeliness
Adults who needed care right away for an illness, injury, or condition in the last 12 months
who sometimes or never got care as soon as wanted
Children who needed care right away for an illness, injury, or condition in the last 12 months
who sometimes or never got care as soon as wanted
Adults’ Ability To Get Care As Soon As Wanted
Adults who needed care right away for an illness, injury, or condition in the last 12 months who sometimes or never got care as soon as wanted, by
insurance (ages 18-64) and race/ethnicity, 2002-2013
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2013.
Note: For this measure, lower rates are better. White and Black are non-Hispanic. Hispanic includes all races.
0
5
10
15
20
25
30
35
40
Pe
rce
nt
Total Private Public Uninsured
0
5
10
15
20
25
30
35
40
Pe
rce
nt
White Black Hispanic
Adults who needed care right away for an illness, injury, or condition in the last 12 months who sometimes or never got care as soon as wanted, by
insurance (ages 18-64) and race/ethnicity, 2002-2013
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2013.
Note: For this measure, lower rates are better. White and Black are non-Hispanic. Hispanic includes all races.
0
5
10
15
20
25
30
35
40
Pe
rce
nt
Total Private Public Uninsured
0
5
10
15
20
25
30
35
40
Pe
rce
nt
White Black Hispanic
Access to Health Care
National Healthcare Quality and Disparities Report | 11
Overall Rate: In 2013, the overall percentage of adults who needed care right away who
sometimes or never got care as soon as wanted was 14.6%.
Trends:
■ From 2002 to 2013, there were no statistically significant changes by insurance in the percentage of adults who needed care right away who sometimes or never got care as soon as wanted. In 2013, the percentages were 32.8% for uninsured people, 23.1% for those with public insurance, and 12.5% for those with private insurance.
■ From 2002 to 2013, there were no statistically significant changes among Whites or Blacks in the percentage of adults who needed care right away who sometimes or never got care as soon as wanted. In 2013, the percentage was 19.8% for Blacks and 13.2%
for Whites.
■ From 2002 to 2013, the percentage of adults who needed care right away who sometimes
or never got care as soon as wanted was improving for Hispanic people (from 25.8% to
16.2%).
Groups With Disparities:
■ In most years, the percentage of adults who needed care right away who sometimes or
never got care as soon as wanted was higher for adults who had public insurance
compared with adults with private insurance.
■ In all years, uninsured adults were less likely than adults with private insurance to receive
needed care right away for an illness, injury, or condition.
■ Although there were no statistically significant changes from 2010 to 2013, by the end of
that period, Hispanics were more likely than Whites to receive care as soon as wanted.
Access to Health Care
12 | National Healthcare Quality and Disparities Report
Children’s Ability To Get Care As Soon As Wanted
Overall Rate: In 2013, the overall percentage of children who needed care right away who sometimes or never got care as soon as wanted was 3.5%.
Trends:
■ From 2002 to 2013, there no statistically significant changes in the percentage of English-
speaking children and children speaking other languages who needed care right away
who sometimes or never got care as soon as wanted.
■ From 2010 to 2013, there were no statistically significant changes in the percentage of
Hispanic and non-Hispanic White children who needed care right away who sometimes
or never got care as soon as wanted.
Groups With Disparities:
■ From 2002 to 2013, Hispanic children were more likely than non-Hispanic White
children to sometimes or never get care as soon as wanted.
Children who needed care right away for an illness, injury, or condition in the last 12 months who sometimes or never got care as soon as wanted, by
preferred language and ethnicity, 2002-2013
0
5
10
15
20
25
Pe
rce
nt
Total English Other
0
5
10
15
20
25
Pe
rce
nt
Hispanic Non-Hispanic White
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2013.
Note: For this measure, lower rates are better. For 2010 and 2013, data for children who spoke a language other than English did not meet the
criteria for statistical reliability, data quality, or confidentiality.
Children who needed care right away for an illness, injury, or condition in the last 12 months who sometimes or never got care as soon as wanted, by
preferred language and ethnicity, 2002-2013
0
5
10
15
20
25
Pe
rce
nt
Total English Other
0
5
10
15
20
25
Pe
rce
nt
Hispanic Non-Hispanic White
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2013.
Note: For this measure, lower rates are better. For 2010 and 2013, data for children who spoke a language other than English did not meet the
criteria for statistical reliability, data quality, or confidentiality.
Access to Health Care
National Healthcare Quality and Disparities Report | 13
Workforce Capacity
Ensuring well-coordinated, high-quality health care requires the establishment of a
supportive health system infrastructure (IOM, 2010).
Key elements include:
■ Well-distributed capable and qualified workforce.
■ Organizational capacity to support culturally competent services and ongoing
improvement efforts.
■ Health care safety net for hospital admissions of vulnerable populations.
Infrastructure Measures
Physicians and surgeons per 100,000 population, by race and ethnicity
Primary care medical residents per 100,000 population, by sex and ethnicity
Characteristics of HRSA-supported health center population versus U.S. population
Distribution of trauma center utilization (Level I and II) for severe injuries in the United
States, by age and geographic location
Medicaid and uninsured discharges in U.S. short-term acute hospitals, by facility
characteristics
Rate of Physicians and Surgeons
Physicians and surgeons per 100,000 population, by race and ethnicity, 2006-2013
0
250
500
750
1,000
1,250
1,500
Rat
e p
er
10
0,0
00
Po
pu
lati
on
White Black Hispanic
0
250
500
750
1,000
1,250
1,500
Rat
e p
er
10
0,0
00
Po
pu
lati
on
White Black Asian AI/AN
Key: AI/AN = American Indian or Alaska Native.
Source: U.S. Census Bureau, American Community Survey, 2006-2013.
Note: The 2008 and 2013 data for AI/ANs did not meet the criteria for statistical reliability, data quality, or confidentiality. White and Black are
non-Hispanic. Hispanic includes all races. The rate of physicians is calculated by dividing the number of reported physicians from the American
Community Survey by the U.S. population sample.
Physicians and surgeons per 100,000 population, by race and ethnicity, 2006-2013
0
250
500
750
1,000
1,250
1,500
Rat
e p
er
10
0,0
00
Po
pu
lati
on
White Black Hispanic
0
250
500
750
1,000
1,250
1,500
Rat
e p
er
10
0,0
00
Po
pu
lati
on
White Black Asian AI/AN
Key: AI/AN = American Indian or Alaska Native.
Source: U.S. Census Bureau, American Community Survey, 2006-2013.
Note: The 2008 and 2013 data for AI/ANs did not meet the criteria for statistical reliability, data quality, or confidentiality. White and Black are
non-Hispanic. Hispanic includes all races. The rate of physicians is calculated by dividing the number of reported physicians from the American
Community Survey by the U.S. population sample.
Access to Health Care
14 | National Healthcare Quality and Disparities Report
Importance:
■ Diversity in the composition of the health care workforce is important because it affects
outcomes, quality, safety, and satisfaction. Racial and ethnic concordance in health care
provider-patient relationships has been shown to improve care. Race-concordant patient-
provider relationships, as opposed to race-discordant, have been found to result in longer
medical visits with higher ratings of positive affect, shared decisionmaking, and
satisfaction (Schoenthaler, et al., 2012).
■ Additional research has found that health care providers from groups underrepresented in
the health professions are more likely to serve minority and economically disadvantaged
patients. It has also been found that Black and Hispanic physicians practice in areas with
larger Black and Hispanic populations than other physicians (Brown, et al., 2009) and
that Black and Hispanic Americans were likely to seek race- concordant physicians due
to several factors, including language accessibility (Saha, et. al., 2000).
■ Further studies have also shown patient trust with providers may influence clinical
outcomes and medication adherence regardless of patient–physician racial/ethnic
composition.
Groups With Disparities:
■ From 2006 to 2013, the rate of physicians per 100,000 population was higher for Asians
than for Whites, Blacks, and American Indians and Alaska Natives (through 2012).
■ From 2006 to 2013, the rate of physicians per 100,000 population was higher for non-
Hispanic Whites than for non-Hispanic Blacks. The rate of physicians per 100,000
population was lower for Hispanics from 2007 to 2013.
Access to Health Care
National Healthcare Quality and Disparities Report | 15
Rate of Primary Care Medical Residents
Importance:
■ Primary care providers and patients who have established clear communication and
trusting relationships can yield better outcomes for patients; however, not all providers
and patients can establish these relationships. Increased racial and ethnic diversity among
primary care medical residents may lend itself to a provider workforce with strong
cultural competency.
Groups With Disparities:
■ In 2013-2014, the rate of primary care medical residents was higher for females than for
males in family medicine, obstetrics and gynecology, and pediatrics. The rate for males
was higher than for females in internal medicine.
■ In 2013-2014, the rate of primary care medical residents was higher for Asians and
Pacific Islanders than for all other racial/ethnic groups, with the highest rate in internal
medicine.
■ In 2013-2014, American Indian and Alaska Native medical residents had the smallest rate
of representation across all medical specialties.
Primary care medical residents per 100,000 population, by sex and race/ethnicity, 2013-2014
0
5
10
15
20
25
30
Rat
e p
er
10
0,0
00
Po
pu
lati
on
Family MedicineInternal MedicineObstetrics and GynecologyPediatrics
0
5
10
15
20
25
30
Rat
e p
er
10
0,0
00
Po
pu
lati
on
Family MedicineInternal MedicineObstetrics and GynecologyPediatrics
Key: AI/AN = American Indian or Alaska Native; API = Asian or Pacific Islander.
Source: Accreditation Council for Graduate Medical Education, Data Resource Book, Academic Year 2013-2014.
http://www.acgme.org/acgmeweb/tabid/259/Publications/GraduateMedicalEducationDataResourceBook.aspx
Note: White, Black, API, and AI/AN are non-Hispanic. Hispanic includes all races. Rates are based on American Community Survey 1-year
population estimates for 2013.
Primary care medical residents per 100,000 population, by sex and race/ethnicity, 2013-2014
0
5
10
15
20
25
30
Rat
e p
er
10
0,0
00
Po
pu
lati
on
Family MedicineInternal MedicineObstetrics and GynecologyPediatrics
0
5
10
15
20
25
30
Rat
e p
er
10
0,0
00
Po
pu
lati
on
Family MedicineInternal MedicineObstetrics and GynecologyPediatrics
Key: AI/AN = American Indian or Alaska Native; API = Asian or Pacific Islander.
Source: Accreditation Council for Graduate Medical Education, Data Resource Book, Academic Year 2013-2014.
http://www.acgme.org/acgmeweb/tabid/259/Publications/GraduateMedicalEducationDataResourceBook.aspx
Note: White, Black, API, and AI/AN are non-Hispanic. Hispanic includes all races. Rates are based on American Community Survey 1-year
population estimates for 2013.
Access to Health Care
16 | National Healthcare Quality and Disparities Report
Patient Characteristics of HRSA Health Center Population
Importance: Patients who receive health care in health centers may experience greater disparities in care compared with the general U.S. population.
Population Differences:
■ In 2014, slightly more than one-third (34.9%) of the health center population was
Hispanic, which was twice as much as the percentage in the U.S. population (17.1%).
Nearly one-quarter (23.4%) of the health center population was Black, almost twice as
much as the percentage in the U.S. population (13.2%).
■ The health center population also had higher percentages of uninsurance (27.9%) and
Medicaid enrollment (47.3%) than the U.S. population (13.4% and 17.3%, respectively).
■ In 2014, 71.2% of the health center population was at or below the Federal poverty level
compared with 14.5% of the U.S. population.
Patient characteristics of HRSA-supported health center population versus U.S. population, 2014
0
10
20
30
40
50
60
70
80
90
100
Per
cen
t
Health Center Population U.S. Population
Key: AI/AN = American Indian or Alaska Native; NHOPI = Native Hawaiian or Other Pacific Islander; FPL = Federal poverty level.
Source: Health Resources and Services Administration, Bureau of Primary Health Care, Uniform Data System, 2014.
http://bphc.hrsa.gov/uds/datasnapshot.aspx.
Note: Racial groups include Hispanics and non-Hispanics. Health center population includes 1,202 program grantees data only.
Patient characteristics of HRSA-supported health center population versus U.S. population, 2014
0
10
20
30
40
50
60
70
80
90
100
Per
cen
t
Health Center Population U.S. Population
Key: AI/AN = American Indian or Alaska Native; NHOPI = Native Hawaiian or Other Pacific Islander; FPL = Federal poverty level.
Source: Health Resources and Services Administration, Bureau of Primary Health Care, Uniform Data System, 2014.
http://bphc.hrsa.gov/uds/datasnapshot.aspx.
Note: Racial groups include Hispanics and non-Hispanics. Health center population includes 1,202 program grantees data only.
Access to Health Care
National Healthcare Quality and Disparities Report | 17
Trauma Center Utilization for Severe Injuries
Trauma care systems were developed to provide complex medical care to injured patients
using a network of care facilities.
Trauma systems are composed of levels ranging from level I to III centers, with level I
denoting the most clinically sophisticated hospital.
The hospital with the highest level is designated as the lead hospital in a trauma care system.
Trauma center levels are:
■ Level I: Required to have a specific number of surgeons and anesthesiologists on duty at
all times, as well as education, prevention, and outreach programs. The 24-hour coverage
of surgery in level I facilities also provides trauma patients with many surgical
specialties, including neurosurgery, as well as radiology, internal medicine, and critical
care.
■ Level II: Provide initial definitive trauma care regardless of the severity of the injury.
When a level II center cannot provide the required care, the patient may be triaged to a
Level I center.
■ Level III: Typically considered community or rural-based hospitals that provide prompt
assessment, resuscitation, stabilization, emergency operations, and treatment. Level III
facilities may transfer patients to hospitals with additional resources.
Distribution of trauma center utilization (level I and II) for severe injuries in the United States, by age, 2010-2013
0
20
40
60
80
100
2010 2011 2012 2013
Pe
rce
nta
ge o
f Se
vere
Inju
rie
s
Total 0-24 25-44 45-64 65+
Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample,
2010-2013.
Distribution of trauma center utilization (level I and II) for severe injuries in the United States, by age, 2010-2013
0
20
40
60
80
100
2010 2011 2012 2013
Pe
rce
nta
ge o
f Se
vere
Inju
rie
s
Total 0-24 25-44 45-64 65+
Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample,
2010-2013.
Access to Health Care
18 | National Healthcare Quality and Disparities Report
Importance: Well-coordinated and timely treatment for trauma patients can prevent needless
injury to those who have suffered from an accident or other life-threating condition. Trauma
centers in the United States provide care for both pediatric and adult populations. People the
age of 45 years use trauma center services at a higher rate.
Trends: From 2010 to 2013, the percentage of people who used trauma centers declined
overall and among people ages 25-44 and 45-64.
Groups With Disparities: From 2010 to 2013, people age 65 and over were less likely to
use level I and II trauma centers than people under age 65.
Trauma Center Utilization, by Geographic Location
Importance: In 2013, patients with intracranial injuries represented 53.6% of trauma center
visits. Triaging patients to level I and II trauma centers with intracranial or other injuries is
driven by many variables, including geographic proximity of the trauma center. Therefore,
residents of rural areas may have difficulty gaining access to care in trauma centers.
Trends: From 2010 to 2013, the percentage of people who used trauma centers declined
among residents of large central metropolitan areas, medium metropolitan areas, and
micropolitan areas.
Distribution of trauma center utilization (Level I and II) for severe injuries in the United States, by geographic location, 2010-2013
0
20
40
60
80
100
2010 2011 2012 2013
Pe
rce
nta
ge o
f Se
vere
In
juri
es
Total Large Central MSA Large Fringe MSA Medium MSA
Small MSA Micropolitan Non-Core
Key: MSA = metropolitan statistical area.
Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample,
2010-2013.
Distribution of trauma center utilization (Level I and II) for severe injuries in the United States, by geographic location, 2010-2013
0
20
40
60
80
100
2010 2011 2012 2013
Pe
rce
nta
ge o
f Se
vere
In
juri
es
Total Large Central MSA Large Fringe MSA Medium MSA
Small MSA Micropolitan Non-Core
Key: MSA = metropolitan statistical area.
Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample,
2010-2013.
Access to Health Care
National Healthcare Quality and Disparities Report | 19
Groups With Disparities: In 2013, 63.8% of residents from a large central metropolitan
area were treated in a level I or II trauma center compared with 50.9% of residents from a
micropolitan area.
Medicaid and Uninsured Hospital Discharges
Importance: Some hospitals contribute to the safety net and provide care for more Medicaid and uninsured patients than others.
Trends:
■ There were no statistically significant changes in Medicaid and uninsured patient
discharges from 2012 to 2013.
Differences Between Types of Hospitals:
■ In 2013, compared with hospitals with 500 or more beds (29.0%), hospitals with bed
sizes under 300 (23.3% for <100 beds and 25.2% for 100-299 beds) had a smaller
percentage of Medicaid or uninsured patients.
■ In 2013, 28.4% of patients in private, for-profit hospitals had Medicaid or were
uninsured, compared with 36.0% in government hospitals.
Rate of Medicaid and uninsured discharges in U.S. short-term acute hospitals, by facility characteristics, 2012-2013
0
10
20
30
40
50
Per
cen
t
2012 2013
Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, HCUPnet, 2013.
Note: Government refers to hospitals that are operated by Federal, State, county, city, or hospital district governments.
Rate of Medicaid and uninsured discharges in U.S. short-term acute hospitals, by facility characteristics, 2012-2013
0
10
20
30
40
50
Per
cen
t
2012 2013
Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, HCUPnet, 2013.
Note: Government refers to hospitals that are operated by Federal, State, county, city, or hospital district governments.
Access to Health Care
20 | National Healthcare Quality and Disparities Report
■ Also in 2013, teaching hospitals (28.5%) had a larger percentage of Medicaid or
uninsured patients compared with nonteaching hospitals (24.6%).
■ In 2013, hospitals in the West and in the South had a greater percentage of Medicaid and
uninsured patients (28.8% and 28.5%, respectively), while hospitals in the Midwest had
the lowest percentage of these patients (23.3%).
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