Health Insurance Access to Care Health Status

 Research

Racial and Ethnic Differencesin Health

2 1996
Suggested citation:

Kass BL, Weinick RM, Monheit AC. Racial and ethnicdifferences in health, 1996. Rockville (MD): Agency forHealth Care Policy and Research; 1999. MEPS ChartbookNo. 2. AHCPR Pub. No. 99-0001.
i

Hispanics of all ages were the most likelyto be uninsured. Nearly 3 in 10 Hispanicchildren had no insurance coverage.Health insuranceHispanics were the least likely to getprivate health insurance through theirjobs. In particular, Hispanic maleworkers were far less likely than otherworkers to have job-related healthcoverage.Blacks were less likely than whites tohave private health insurance. However,they were the group most likely to bepublicly insured.

Access to care

Hispanics were the least likely to have ausual source of health care.

Blacks and Hispanics were more likelythan others to have a hospital-basedusual source of care.

Families headed by Hispanics were themost likely to report barriers toobtaining the health care they needed.

Hispanics and blacks were less likelythan whites to be in excellent health andmore likely to be in fair or poor health.Health status

Medical Expenditure Panel Survey

This report presents estimates of health insurance coverage, access to health care, and health status for Hispanic, black, and white Americans. Key findings include:
iii

1 Introduction3 Source of Data for This Report5 Section 1

Health Insurance

13 Section 2

Access to Health Care

19 Section 3

Health Status

23 Conclusions24 Looking Ahead

Future MEPS Data

25 References26 Notes

Medical Expenditure Panel Survey
Despite many recent

improvements in the health ofAmericans, substantial differencesstill exist between racial and ethnicgroups. These differences are thefocus of considerable publicattention, and in 1998 the ClintonAdministration announced a newnational effort to eliminate racialand ethnic gaps in Americans’health (the Initiative to EliminateRacial and Ethnic Disparities inHealth).

Differences in the health of

racial and ethnic groups may resultfrom differences in their experienceswith our health care system. Thisreport focuses on three key aspects

of racial and ethnic differences inhealth and health care. The firstsection presents data on the healthinsurance status of black, Hispanic,and white Americans. Since healthinsurance is just one of the factorsthat may influence racial and ethnicdifferences in health, the secondsection of the report addressesaccess to health care, described interms of usual sources of care andbarriers to care. Finally, the thirdsection turns to the motivating forcebehind our Nation’s interest in thistopic: differences in health statusamong American racial and ethnicgroups.

Medical Expenditure Panel Survey

1
Source of

DataforThis

Report

The estimates presented in this

report are drawn from the MedicalExpenditure Panel Survey (MEPS).MEPS is the third in a series ofmedical expenditure surveysconducted by the Agency forHealth Care Policy and Research. Itis a nationally representative surveythat collects detailed information onhealth status, health care use andexpenses, and health insurancecoverage of individuals and familiesin the United States.

These data come from the first

and second rounds of interviewingfor the Household Component ofthe 1996 panel of MEPS. (See Note1.) The estimates presented here are

nationally representative of thecivilian noninstitutionalizedpopulation. MEPS data are releasedto the public in a number offormats, including public use datafiles and the printed MEPS ResearchFindings and MEPS Highlightsseries. The numbers shown in thischartbook are drawn from a varietyof the Research Findings reports as

well as additional analysesconducted by the MEPS staff.Specific sources for the informationpresented here are listed in thereferences section.

In some cases, totals may not

add precisely to 100 percent as aconsequence of rounding. The racialcategory “white/other,” used insome charts, includes a number ofindividuals identified as Asians,American Indians, Aleuts, Eskimos,or other races. The health of thesegroups is of interest, but MEPSincludes too few individuals topresent data on them. Unlessotherwise noted, only differencesthat are statistically significant at the0.05 level are discussed in the text.

Medical Expenditure Panel Survey

3
Health

Insurance

Health insurance plays a critical

role in ensuring that Americansobtain timely medical care and haveprotection against expensive healthcare costs. This section describes thehealth insurance coverage of variousracial and ethnic groups. MEPSgroups health insurance into threecategories. Those people grouped as“any private” had private healthinsurance at any time during thestudy. For example, people who hadhealth care coverage from theirworkplace for 1 month would beconsidered privately insured. Peoplewho had no private coverage at anytime during the study but who hadpublic insurance such as Medicaidor Medicare are described as “publiconly.” People who did not haveprivate or public insurance at anytime during the study are describedas “uninsured.” (See Note 1.)

Medical Expenditure Panel Survey

5
Medical Expenditure Panel Survey

Who has coverage and who doesn’t?

Hispanic Black White

22.5%

48.6%

11.6%

33.5% 22.9%

13.1%

44.0%

28.4% 75.3%

, all ages

Black and Hispanic Americans

were more likely than whites to beuninsured. Blacks were the mostlikely to be publicly insured, whilewhites were the most likely to haveprivate coverage.

• Less than half of all Hispanics

and blacks had private healthinsurance, compared to threefourths of whites.

• Over one-fifth of all Hispanics

and over one-fourth of blackshad only public insurance,compared to one-tenth of whites.

• Hispanics and blacks were much

more likely than whites to beuninsured.
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the most

private health

in the United

panic and black

 were less likely

 to have job

ance.

• Slightly more than half of

Hispanic workers and two-thirdsof black workers had job-relatedinsurance, compared to overthree-quarters of white workers.

7

Medical Expenditure Panel Survey

me racial and ethnic groups more

o have job-related insurance?

Hispanic Black White

45.1% 34.0%

22.6%

54.9%

66.0% 77.4%

related insurance

 insurance

h insurance, workers ages 16-64
Although people in the

white/other group represented morethan half of the uninsuredpopulation, Hispanics and blackswere disproportionately representedamong the uninsured.

• Hispanics represented only 11.6

percent of the U.S. populationunder age 65 but accounted for21.2 percent of the uninsuredpopulation.

• Similarly, blacks represented 13.1

percent of the non-elderly U.S.population but 16.9 percent ofthe uninsured population.

• In contrast, the white/other

group represented 75.3 percentof the non-elderly U.S.population but only 61.9 percentof the uninsured population.

Medical Expenditure Panel Survey

Are certain racial/ethnic groups morelikely to be uninsured?

HispanicBlackWhite/other

pulation Uninsured population

%%%

16.9%61.9%21.2%

r age 65
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mportant factor in

ween

health insurance

ce coverage was

s and females in

nic group. 

l/ethnic groups,

ore likely than

ublic insurance.

were substantially

be uninsured than

p.

9

Medical Expenditure Panel Survey

s the role of gender in insurance

ge?

0

20406080

100

Male

Any private

Public only

Uninsured

Female Female Male Female

Percent

Male

37.2 29.619.7

43.1

25.025.1

50.0

21.2

75.3

47.5

12.8

31.3

75.3

44.9

25.5

14.4 11.9

Hispanic Black White

10.3

Health insurance, all ages
Medical Expenditure Panel Survey

Young adults ages 19-24 were

the age group most likely to lackhealth care coverage.

• About one-third of Hispanic and

black young men and womenhad private insurance coverage.In contrast, more than 60percent of white young adultshad such coverage.

• Among young adults, Hispanic

and black women were far morelikely to be publicly insured thantheir male counterparts. Theywere also more likely than youngwhite women to have publiccoverage.

• Among young adults of both

sexes, Hispanics and blacks weremore likely than their whitecounterparts to be uninsured.

th insurance different for young

?

Any private

Public only

Uninsured

emale Male Female Male Female

61.8

45.918.535.5

61.1 33.5

4.4

34.6

41.7 28.9

23.135.2

4.6

63.2

7.9

c Black White

nce, ages 19-24
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11

Medical Expenditure Panel Survey

re gender differences in job-related

nsurance among racial/ethnic groups?

workers were far less likely than all other workers to have health

n employer. Only half of Hispanic male workers obtained job

overage, compared with two-thirds of black male workers and

f white male workers.

 workers were much more likely than Hispanic male workers to

 coverage.

orkers were more likely than their Hispanic or black counterparts

ted health coverage.

Percent with job-related health insurance, workers ages 16-64

0

20406080

Women

Men

Black White

Percent49.7

62.4 66.0 66.0

76.0 79.1

Hispanic
• Hispanic children were the most

likely to be uninsured. Theywere more than twice as likely aswhite children to have noinsurance coverage.

• White children were far more

likely than either black orHispanic children to have privatehealth insurance.

• Black children were the most

likely to have public health carecoverage (40.8 percent),followed by Hispanic (32.5percent) and white (13.1percent) children.

Medical Expenditure Panel Survey

ldren in certain racial/ethnic groups

ikely to lack health insurance?

Hispanic Black White

32.5% 40.8%

39.8% 13.1% 41.7%

12.2%

27.7%

17.6%

74.7%

Health insurance, children under age 18
Medical Expenditure Panel Survey

13

Access to

Health Care

Adequate access to health care

services can significantly influencehealth care use and healthoutcomes. One way to measureaccess to care is to ask whetherpeople have a usual source of care –a person or place they usually go toif they are sick or need advice abouttheir health. Lacking a usual sourceof care may also have importantimplications for the quality andcontinuity of care received. Inaddition, even people who have ausual source of care may experiencebarriers to receiving services becauseof financial or insurance restrictions,lack of availability of providers atnight or on weekends, or otherdifficulties.

This section describes racial and

ethnic differences in usual sources ofcare and barriers to obtainingneeded health care.
Hispanic and black Americans

were substantially less likely thanother Americans to have a usualsource of health care.

• Hispanics were the least likely to

have a usual source of care.

• Over three-fourths of the

white/other group (76.3percent) had an office-basedusual source of care, comparedwith 57.9 percent of Hispanicsand 63.6 percent of blacks.

• Blacks and Hispanics were more

likely than the white/othergroup to have a hospital-basedusual source of care.

Medical Expenditure Panel Survey

Are different racial/ethnic groups lesslikely to have a usual source of care?

ce of care, all ages

NoneHospital-basedOffice-based

Hispanic Black White/other

12.5

29.6

16.2

63.6

20.2

76.3

15.5

8.1
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15

Medical Expenditure Panel Survey

lack children

n white children

al source of care

ce-based source of

en were less likely

n any other

oup to have a

health care.

were twice as

hildren to have

 of health care.

lack children were

white children to

based usual source

e more likely to

based source of

Percent

0

20406080

100

NoneHospital-basedOffice-based

Hispanic Black White

69.1

17.2 13.7

71.0

16.4 12.6

86.8

7.2 6.0

Usual source of care, children under age 18

ldren in some racial/ethnic groups more

o be without a usual source of care?
Medical Expenditure Panel Survey

Families headed by Hispanics

were the most likely to report havingdifficulty, delaying, or not receivinghealth care they needed.

tain racial/ethnic groups more likely

barriers to receiving health care?

048

1216

Hispanic Black White

Percent

15.1

9.9

11.4

Percent of families with barriers to obtainingneeded health care
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17

Medical Expenditure Panel Survey

s that

ems in receiving

by Hispanics

e more likely than

rsons in the

 (58.5 percent) to

 health care.

ypes of health care barriers do

nt racial/ethnic groups experience?

Other reasons

Insurance-related reasons (See Note 2)

Unable to afford care

Hispanic Black White/other

15.8%

12.3% 20.9%

15.0%

27.3% 20.6%

69.1% 60.4% 58.5%

Main problem encountered by families with barriers to care
Health Status President Clinton’s Initiative on Race calls for eliminating racial and

ethnic disparities in selected healthproblems by the year 2010. Asstated in the Initiative, the health ofAmericans overall has improved overthe past 5 years. However, blacksand Hispanics are still more likelythan white Americans to report thatthey have poor health.

Answers to simple questions

like the one reported here, whichasked, “Would you rate this person’shealth as excellent, very good,good, fair, or poor?” have beenshown to predict both demand formedical care services and medicaloutcomes.

Medical Expenditure Panel Survey

19
• Hispanics and blacks were more

likely than whites to be in fair orpoor health. Over 17 percent ofHispanics and 16 percent ofblacks were in fair or poorhealth, as compared with lessthan 10 percent of whites.

• Hispanics and blacks were less

likely than whites to be inexcellent health.

Does health status differ betweenracial/ethnic groups?

Medical Expenditure Panel Survey

0

20406080

100

Black

Fair/poorExcellentVery goodGood

Black White

Percent

26.817.426.828.9

29.316.127.027.7

34.69.933.0

22.5

Hispanic

Health status, ages 18-64
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21

Medical Expenditure Panel Survey

at is the role of gender in health status?

alth was more

g Hispanics and

ong whites for

 females.

each racial/

ere more likely

 counterparts to

or health.

05

101520

Females

Males

Black White

Percent

12.4

12.9 12.5

16.9

15.3

9.6

11.0

Hispanic

Percent in fair or poor health, all ages
Medical Expenditure Panel Survey

ldren in different racial/ethnic groups

er risk of being in poor health?

• Hispanic children were the most

likely to be in fair or poor health.

• Black and Hispanic children were

less likely than white children tobe in excellent health. Just over55 percent of white childrenwere in excellent health,compared to approximately 43percent of Hispanic and 48percent of black children.

Fair/poorExcellentVery goodGood

Black White

48.121.526.2

4.2

55.313.128.7

2.9

ic Black

ildren under age 18
Medical Expenditure Panel Survey

23

The data presentedin this reportsuggest thatHispanic and blackAmericans are morelikely than whiteAmericans to:

Lack private job-related health insurance coverage. Be uninsured. Lack a usual source of care. Have a hospital-based usual source of care.

These data provide a snapshot

of racial and ethnic disparities in avariety of measures of health in1996. Future MEPS data can beused to follow trends in thesemeasures over time, as well as toprovide additional information onracial and ethnic disparities in health.

Be in fair or poor health.
Medical Expenditure Panel Survey

Future MEPS Data This report presents estimates of health insurance coverage, access to health care, and health status. Future data from MEPS will address additional aspects of health care, including: • The impact of managed care. • Use of specific services. • Use of preventive health services. • Amounts paid for health care and sources of payment.

• Additional measures of health

status, including healthconditions and functionallimitations.

• Amounts families pay for private

health insurance coverage.

MEPS is a unique data resource

for monitoring our Nation’s healthcare system. As an ongoing survey,MEPS will produce data that can beused to examine changes over time.

references
The following references served

as source material for this chartbook.Each reference shows in parenthesesthe chartbook pages derived fromthat source.

Monheit AC, Vistnes JP. Health insurance

status of workers and their families: 1996.Rockville (MD): Agency for Health CarePolicy and Research; 1997. MEPSResearch Findings No. 2. AHCPR Pub.No. 97-0065. (Chartbook pages 7 and11)

Vistnes JP, Monheit AC. Health insurance

status of the civilian noninstitutionalizedpopulation: 1996. Rockville (MD):Agency for Health Care Policy andResearch; 1997. MEPS Research FindingsNo. 1. AHCPR Pub. No. 97-0030.(Chartbook pages 6, 8, 9, and 10)

Weigers M, Drilea SK. Perceived health

status and functional limitations amongminorities: a comparison of Hispanics,blacks, and whites. Rockville (MD):Agency for Health Care Policy andResearch; 1999 (forthcoming). MEPSResearch Findings. (Chartbook pages 20and 21)

Weinick RM, Weigers ME, Cohen JW.

Children’s health insurance, access to care,and health status: new findings. Health

Affairs 1998;17:127-136. (Chartbookpages 12, 15, and 22).

Weinick RM, Zuvekas SH, Drilea SK. Access

to health care—sources and barriers, 1996.Rockville (MD): Agency for Health CarePolicy and Research; 1997. MEPS

Research Findings No. 3. AHCPR Pub.No. 98-0001. (Chartbook pages 14, 16,and 17)

Please consult the MEPS Web site at

http://www.meps.ahcpr.gov/

for an updated publications list or additional

copies of this publication. Contact the MEPS

information coordinator at AHCPR

(301-594-1406) for additional information.

Medical Expenditure Panel Survey

25
Note 1: Data collection for Round 1 took place from March through July

1996 and asked about health-related issues for the period fromJanuary 1, 1996, to the date of the Round 1 interview. Round 2data collection occurred during the period from August toNovember 1996 and asked survey respondents to report onhealth-related issues between the date of the first interview andthe date of the second interview. All data concerning healthinsurance, health status, and demographics presented in thischartbook come from Round 1 of the survey. Health insuranceand health status estimates should therefore be interpreted asestimates for experiences during the first half of 1996. Informationon access to care was obtained in Round 2 of the survey; however,the questions on access to care generally did not ask about aspecific time period.

Note 2: Insurance-related reasons include “insurance company wouldn’t

approve, cover, or pay for care,” “pre-existing condition,”“insurance required a referral but couldn’t get one,” and “doctorrefused to accept family’s insurance plan.”

Medical Expenditure Panel Survey