Racial and Ethnic Inequality in Health Care Access and

Quality: Ohio Family Health Survey 2008/9

Jennifer Malat, PhD

Jeffrey Timberlake, PhD

Department of Sociology

Background

• Defining race and ethnicity

• Racial and ethnic disparities in health and health care– Access to health care– Quality of care– Past research on explanations

Research Questions• What are the extent of racial/ethnic differences in

access to health care and health care quality among adult Ohioans in 2008/9?

• What are the trends in access to health care and health care quality for the racial/ethnic groups between 2003/4 and 2008/9?

• To what extent do insurance coverage and type as well as other individual-level factors account for racial/ethnic differences in health care access and quality in 2008/9?

Access to Care: Source of Care

0%

20%

40%

60%

80%

White Black Hispanic Asian

Dr.'s Office/HMOClinicHospital facilityOtherNone

Access to Care: Source of Care

Usual source of care by race/ethnicity and year

Hispanic HispanicUsual source for care White Black Asian (all races) White Black Asian (all races)

Doctor/HMO 73.8% 48.3% 60.6% 46.2% 72.9% 45.8% 60.4% 37.2%Clinic 12.2% 25.9% 22.9% 26.7% 10.3% 22.8% 21.5% 26.6%Hospital ED/outpatient/urgent care 6.8% 18.3% 5.2% 14.2% 8.1% 20.9% 8.4% 13.0%Other 1.0% 1.0% 1.7% 1.3% 1.0% 1.8% 0.6% 1.2%None 6.1% 6.5% 9.6% 11.6% 7.6% 8.8% 9.1% 22.0%

Non-Hispanic Non-Hispanic2008/92003/4

Access to Care:Usual Health Care Provider

0%

4%

8%

12%

16%

20%

White Black Hispanic AsianAmerican

Note: Only among those with a usual source of health care

Access to Care:Unmet Health Care Need

0%

4%

8%

12%

16%

20%

White Black Hispanic AsianAmerican

Access to Care:Travel Time to Care

0%

10%

20%

30%

40%

50%

White Black Hispanic Asian

Note: Only among those with a usual source of health care

Quality of Care:Patient Satisfaction

0%

20%

40%

60%

80%

100%

White Black AsianAmerican

Hispanic

2003/42008/9

Policy Implications

• Complexity of problem of disparities

• Increase insurance coverage

• Income and education equality

• Community health centers

• Translation services

Policy Implications, continued

• Transportation vouchers

• Electronic medical records

• Public and provider awareness

• Greater overall equality

Means of Dependent Variables, by Racial/Ethnic Group and Wave of OFHS

Hispanic HispanicDependent variables White Black Asian Other (all races) White Black Asian Other (all races)

Usual place for careDoctor/HMO 0.738 0.483 0.606 0.608 0.462 0.729 0.458 0.604 0.605 0.372Clinic 0.122 0.259 0.229 0.135 0.267 0.103 0.228 0.215 0.157 0.266Hospital ED/outpatient/urgent care 0.068 0.183 0.052 0.168 0.142 0.081 0.209 0.084 0.127 0.130Other 0.010 0.010 0.017 0.014 0.013 0.010 0.018 0.006 0.015 0.012None 0.061 0.065 0.096 0.075 0.116 0.076 0.088 0.091 0.095 0.220

Dissatisfaction with health care quality 0.195 0.285 0.363 0.264 0.233 0.223 0.350 0.324 0.343 0.320Does not usually see same doctor Ń Ń Ń Ń Ń 0.081 0.174 0.115 0.100 0.117Did not get needed care in last year Ń Ń Ń Ń Ń 0.138 0.174 0.073 0.229 0.149Greater than median time to routine care Ń Ń Ń Ń Ń 0.369 0.442 0.390 0.427 0.400

Notes: Data are weighted. Proxy respondents deleted from analysis.

Non-Hispanic Non-Hispanic20082003/4

Handout Appendix: Table of Means