Variation in participation in health care settings associated with race and ethnicity

Erika B. Bliss, MD; David S. Meyers, MD; Robert L. Phillips, Jr., MD, MSPH; George E. Fryer, PhD; Susan M. Dovey, MPH, PhD; and Larry A. Green, MD

OBJECTIVE: To use the ecology model of health care to contrast participation of Black, Non-Hispanics (Blacks), White, Non-Hispanics (Whites), and Hispanics of any race (Hispanics) in five health care settings and determine whether disparities between those individuals exist among places where they receive care. DESIGN: 1996 Medical Expenditure Panel Survey data were used to estimate the number of Black, White, and Hispanic people per thousand receiving health care in each setting. SETTING: physicians’ offices, outpatient clinics, hospital emergency departments, hospitals, and people’s homes. MAIN OUTCOME MEASURE: Number of people per 1000 per month who had at least one contact in a health care setting. RESULTS: Fewer Blacks and Hispanics than Whites received care in physicians’ offices (154 vs 155 vs 244 per 1000 per month, respectively) and outpatient clinics (15 vs 12 vs 24 per 1000 per month, respectively). There were no significant differences in proportions hospitalized or receiving care in emergency departments. Fewer Hispanics than Blacks or Whites received home health care services (7 vs 14 vs 14 per 1000 per month, respectively). After controlling for 7 variables, Blacks and Hispanics were less likely than Whites to receive care in physicians’ offices [Odds Ratio (OR) = 0.65, 95% Confidence Interval (CI) = 0.60-0.69 for Blacks and OR = 0.79, 95% CI = 0.73-0.85 for Hispanics], outpatient clinics (OR = 0.73, 95% CI = 0.60-0.90 for Blacks and OR = .71, 95% CI = 0.58-0.88 for Hispanics), and hospital emergency departments (OR = 0.80, 95% CI = 0.69-0.94 for Blacks and OR = 0.80, 95% CI = 0.68-0.93 for Hispanics) in a typical month. There was no significant difference between the groups in the likelihood of receiving care in the hospital or at home. CONCLUSIONS: Fewer blacks and Hispanics than whites received healthcare in physicians’ offices, outpatient clinics, and emergency departments in contrast to hospitals and home care. Research and programs aimed at reducing disparities in receipt of care specifically in the outpatient setting may have an important role in the quest to reduce racial and ethnic disparities in health.

Bliss EB, Meyers DS, Phillips RL, Fryer GE, Dovey SM, Green LA. Variation in participation in health care settings associated with race and ethnicity. J Gen Intern Med 2004;19:931-936.