The Contribution of Insurance Coverage and Community Resources to Reducing Racial/Ethnic Disparities in Access to Care

Hargraves, J. Lee; Hadley, Jack

doi:10.1111/1475-6773.00148

Cited by 284 publications

(201 citation statements)

References 37 publications

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“…Vulnerable populations oftentimes lack high quality and continuity of medical care, leading them to seek more proximal and perhaps unconventional health resources. (Hargraves and Hadley 2003) Similarly, some unconventional self-care strategies may be more familiar to older adults who, over their life course, have not had extensive access to conventional medical care. (Schoenberg and Drew 2002) Finally, individuals with chronic disease, particularly those with co-morbidities, are more likely to engage unconventional healers (herbalists, spiritualists) and self-care than those without chronic disease.…”

Section: Self-carementioning

confidence: 99%

Diabetes Self-care among a Multiethnic Sample of Older Adults

Schoenberg

Traywick²,

Jacobs-Lawson

et al. 2008

J Cross Cult Gerontol

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Type 2 diabetes constitutes a leading and increasing cause of morbidity and mortality among older adults, particularly African Americans, Native Americans, Mexican Americans, and rural dwellers. To understand diabetes self-care, an essential determinant of diabetic and overall health outcomes, 80 middle aged and older adults from these four disproportionately affected racial/ ethnic/residential groups engaged in in-depth interviews, focusing on approaches to and explanations for diabetes self-care. Certain self-care activities (medication-taking, diet, foot care) were performed regularly while others (blood glucose monitoring, exercise) were practiced less frequently. Despite research suggestions to the contrary, only one in four elders used unconventional diabetes therapies, and only one-third listed someone other than a health care provider as a primary information source. Few self-care differences emerged according to race/ ethnicity/residence, perhaps because of the influential and common circumstance of low income. Thematic analyses suggest that inadequate resources, perceived efficacy of medication, great respect for biomedical authority, and lack of familiarity with and concerns about unconventional therapies are influential in establishing these patterns of self-care. We discuss the similarity of self-care practices and perspectives irrespective of race/ethnicity/residence and the predominance of biomedical acceptability.

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Section: Self-carementioning

confidence: 99%

Diabetes Self-care among a Multiethnic Sample of Older Adults

Schoenberg

Traywick²,

Jacobs-Lawson

et al. 2008

J Cross Cult Gerontol

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“…2 Studies have measured these factors using income level and insurance status to represent socioeconomic status (SES) and access to healthcare, respectively. 2,10 Household income and insured status also account for a significant amount of the racial disparity in usual source of care. 10,11 However, even after accounting for individual-level socioeconomic factors, the disparity in usual source of care persists.…”

mentioning

confidence: 99%

“…2,10 Household income and insured status also account for a significant amount of the racial disparity in usual source of care. 10,11 However, even after accounting for individual-level socioeconomic factors, the disparity in usual source of care persists. 10,11 Such a significant public health problem begs further exploration.…”

mentioning

confidence: 99%

“…10,11 However, even after accounting for individual-level socioeconomic factors, the disparity in usual source of care persists. 10,11 Such a significant public health problem begs further exploration. Psychosocial factors, like medical mistrust and perceived discrimination, have been identified as determinants of healthcare utilization, yet few studies have examined the effect of psychosocial determinants like medical mistrust on usual source of care disparities.…”

mentioning

confidence: 99%

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Race, Medical Mistrust, and Segregation in Primary Care as Usual Source of Care: Findings from the Exploring Health Disparities in Integrated Communities Study

et al. 2016

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Compared to White Americans, African-Americans are less likely to use primary care (PC) as their usual source of care. This is generally attributed to race differences in socioeconomic status and in access to primary care services. Little is known about the relationship between race differences in medical mistrust and the usual source of care disparity. Using data from the Exploring Health Disparities in Integrated Communities (EHDIC) study, we examined the role of medical mistrust in choosing usual source of care in 1408 black and white adults who were exposed to the same healthcare facilities and low-income racially integrated community. Multinomial logistic regression models were estimated to examine the relationship between race, medical mistrust, and usual source of care. After adjusting for demographic and health-related factors, African-Americans were more likely than whites to use the emergency department (ED) (relative risk ratio [RRR] = 1.43 (95 % confidence interval (CI) [1.06-1.94])) and hospital outpatient department (RRR1.50 (95 %CI [1.10-2.05])) versus primary care as a usual source of care. When medical mistrust was added to the model, the gap between African-Americans' and whites' risk of using the ED versus primary care as a usual source of care closed (RRR = 1.29; 95 % CI [0.91-1.83]). However, race differences in the use of the hospital outpatient department remained even after accounting for medical mistrust (RRR = 1.67; 95 % CI [1.16-2.40]). Accounting for medical mistrust eliminated the ED-as-usual-source of care disparity. This study highlights the importance of medical mistrust as an intervention point for decreasing ED use as a usual source of care by low-income, urban African-Americans.

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“…34,35 Racial/ethnic disparities in health and medical care have been associated with health insurance, 36,37 sociodemographic factors, 38,39 and elements of the health care system such as accessibility and use of a medical home or usual source of care (USC). 14,[40][41][42][43] Little is known about the potential for a change in disparities after providing health insurance to children who might otherwise be uninsured.…”

mentioning

confidence: 99%

Reduction in Racial and Ethnic Disparities After Enrollment in the State Children's Health Insurance Program

Shone¹,

et al. 2005

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ABSTRACT. Background. Racial/ethnic disparities are associated with lack of health insurance. Although the State Children's Health Insurance Program (SCHIP) provides health insurance to low-income children, many of whom are members of racial/ethnic minority groups, little is known about whether SCHIP affects racial/ethnic disparities among children who enroll.Objectives. The objectives of this study were to (1) describe demographic characteristics and previous health insurance experiences of SCHIP enrollees by race, (2) compare racial/ethnic disparities in medical care access, continuity, and quality before and during SCHIP, and (3) determine whether disparities before or during SCHIP are explained by sociodemographic and health system factors.Methods. Pre/post-parent telephone survey was conducted just after SCHIP enrollment and 1 year after enrollment of 2290 children who had an enrollment start date in New York State's SCHIP between November 2000 and March 2001, stratified by race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic). The main outcome measures were usual source of care (USC), preventive care use, unmet needs, patterns of USC use, and parent-rated quality of care before versus during SCHIP.Results. Children were white (25%), black (31%), or Hispanic (44%); 62% were uninsured >12 months before SCHIP. Before SCHIP, a greater proportion of white children had a USC compared with black or Hispanic children (95%, 86%, and 81%, respectively). Nearly all children had a USC during SCHIP (98%, 95%, and 98%, respectively). Before SCHIP, black children had significantly greater levels of unmet need relative to white children (38% vs 27%), whereas white and Hispanic children did not differ significantly (27% vs 29%). During SCHIP, racial/ethnic disparities in unmet need were eliminated, with unmet need at 19% for all 3 racial/ethnic groups. Before SCHIP, more white children made all/ most visits to their USC relative to black or Hispanic children (61%, 54%, and 34%, respectively); all improved during SCHIP with no remaining disparities (87%, 86%, and 92%, respectively). Parent-rated visit quality improved for all groups, but preexisting racial/ethnic disparities remained during SCHIP, with improved yet relatively lower levels of satisfaction among parents of Hispanic children. Sociodemographic and health system factors did not explain disparities in either period.Conclusions. Enrollment in SCHIP was associated with (1) improvement in access, continuity, and quality of care for all racial/ethnic groups and (2) reduction in preexisting racial/ethnic disparities in access, unmet need, and continuity of care. Racial/ethnic disparities in quality of care remained, despite improvements for all racial groups. Sociodemographic and health system factors did not add to the understanding of racial/ethnic disparities. SCHIP improves care for vulnerable children and reduces preexisting racial/ethnic disparities in health care. R acial/ethnic disparities in health care delivery are associated with adverse hea...

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The Contribution of Insurance Coverage and Community Resources to Reducing Racial/Ethnic Disparities in Access to Care

Cited by 284 publications

References 37 publications

Diabetes Self-care among a Multiethnic Sample of Older Adults

Diabetes Self-care among a Multiethnic Sample of Older Adults

Race, Medical Mistrust, and Segregation in Primary Care as Usual Source of Care: Findings from the Exploring Health Disparities in Integrated Communities Study

Reduction in Racial and Ethnic Disparities After Enrollment in the State Children's Health Insurance Program

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