Study identifies key factors that determine African-Americans’ use of health care system


Sept. 1, 2004

WASHINGTON — A new study shows that the strongest changeable factors predicting use of health care services by African-Americans were having health insurance and a regular physician or place they visited for health care. The research from the National Center for Primary Care (NCPC) at Morehouse School of Medicine in Atlanta, Ga., and the Robert Graham Center: Policy Studies in Family Medicine and Primary Care in Washington,D.C., was published in the September edition of the Journal of the National Medical Association.

"To improve the health and health care of African-Americans, we need to focus on making changes that have the biggest impact," said Robert L. Phillips, Jr., MD, assistant director of the Graham Center and co-author of the study. "Our research shows that whether or not individuals have health insurance and/or a primary care medical home have a dramatic effect on patterns of health care for African-American patients. Poverty was also a significant factor and is also a changeable characteristic."

Racial and ethnic disparities in health care have been documented in numerous studies. However, the disparities studies have tended to lump together modifiable risk factors with nonmodifiable demographic characteristics of the individual in explaining variations in the use of health care services.

"We have tended to say ‘poor-black-and-uninsured' all together as if they were one word or one big category," said George Rust, M.D., M.P.H., lead author of the study and deputy director of NCPC.

Instead, this study sought to assess modifiable characteristics that make a difference in use of health care services within the African-American community. This study explored why some African-American patients receive optimal care while others do not. The goal was to identify specific factors around which efforts can be designed to reduce health disparities.

Other published research shows that African-American patients are significantly less likely than whites to receive influenza vaccine, more likely to report barriers to obtaining mammography, more likely to be diagnosed with late-stage cancer, and more likely to die from cancer.

Only one in five the respondents to the study survey reported having a usual source of care. Slightly more than half the respondents to the study survey were in the middle income or high income category. Over half had private health insurance, slightly more than one in four were covered by public health insurance, and approximately one in seven had no health insurance at all.

Findings also include:

Those with only public health insurance were much greater consumers of health care than the uninsured, reflecting higher use by the elderly (Medicare/Medicaid) and by the poor (Medicaid).

Uninsured African-Americans were less likely to get health care in all health care service settings other than the emergency room than were those who had private health insurance and those eligible for Medicare or Medicaid.

Near-poor African-Americans, who may not qualify for Medicaid or be able to afford private insurance, had worse health status than either the poor or any other income group.

African-Americans with a usual source of care -- a regular physician or health care setting -- also used outpatient visits, inpatient hospital bed-days, and prescription drugs two to four times more often than those without a usual source of care.

"Health disparities are not inevitable. There are things we can fix, like making sure everyone has health insurance and their own personal primary care physician," explained Rust.

"The factors we identified -- having health insurance, having a medical home, and poverty -- aren't easily changed and will require significant shifts in private and public policy and funding, and possibly government intervention," said Phillips.

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Note to journalists: To interview Dr. Phillips, or to obtain a copy of the article, please contact Maureen Maxwell at (202) 232-9033, (800) 274-2237, or

To interview Dr. Rust, please contact the Office of Public Affairs at Morehouse School of Medicine at (404) 752-1752 or

The Journal of the National Medical Association can be accessed at


About the Robert Graham Center

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.

Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.