There is no single gold standard for adjusting health expenditures for inflation. Our discussion of best practices can help researchers select the index best suited to their study.

We examine the roles that insurance coverage, the delivery system, and external factors play in explaining persistent disparities in access among racial and ethnic groups of all ages. Using data from the 1996-1999 Medical Expenditure Panel Surveys and regression-based decomposition methods, we find that our measures of health care system capacity explain little and that while insurance clearly matters, external factors are equally important. Employment, job characteristics, and marital status are key determinants of disparities in access to insurance but are difficult for health policy to affect directly. Much of existing disparities remains unexplained, presenting a challenge to developing policies to eliminate them.

Objective We examined the utilization of stimulant medications for ADHD treatment among U.S. children during the period 1996–2008 to determine trends by age, sex, race/ethnicity, family income, and geographical location. Method The 1996–2008 database of the Medical Expenditure Panel Survey, a public, nationally representative, annual survey of U.S. households, was analyzed for therapeutic stimulant use under age 19. The data for the year 1987 were also recalculated for reference. Results An estimated 3.5% (95% C.I. 3.0–4.1) of U.S. children received stimulant medication in 2008, up from 2.4% in 1996 (p<.01). Over the period 1996–2008, use increased consistently at an overall annual growth rate of 3.4%. Use increased in adolescents (annual growth: 6.5%), but did not significantly change in 6–12 year old children, and decreased in preschoolers. Use remained higher in males than females, and consistently lower in the West than in other U.S. areas. While differences by family income have disappeared over time, the use is significantly lower among racial and ethnic minorities. Conclusions Overall, pediatric stimulant use has been slowly but constantly increasing over the last 12 years, primarily due to greater use among adolescents. Use among preschoolers remains low and has declined over time. Important variations related to racial/ethnic background and geographical location persist, thus indicating a substantial heterogeneity in the approach to the treatment of ADHD in U.S. communities.

This article focuses on racial and ethnic disparities in health care, describing both absolute differences and relative changes in access to care and the use of health services among whites, blacks, and Hispanics over the past two decades. Using data from a series of three nationally representative medical expenditure surveys, the authors present descriptive statistics on disparities in access and use between minorities and whites over time. They also use multivariate analyses to isolate the extent to which health insurance and income explain those disparities. The authors find that disparities increased between 1977 and 1996, particularly for Hispanic Americans. Results also show that approximately one half to three quarters of the disparities observed in 1996 would remain even if racial and ethnic disparities in income and health insurance coverage were eliminated.

Researchers and policymakers may need to broaden the scope of factors they consider as barriers to access if the goal of eliminating disparities in health care is to be achieved.