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October 4, 1999

Minorities' Primary Health Care Substandard Compared To Whites'

A study has shown that racial and ethnic minority patients in the United States received primary care that was inferior to that received by whites. Specifically, minority patients, who were significantly more likely to list a hospital setting as their usual source of care rather than a private physician or clinic, found it more difficult to get an appointment and waited longer to see a physician during appointments. These disparities persisted even after the researcher controlled for possible racial or ethnic disparities in socioeconomic and health status characteristics. The study appeared in the October 1999 issue of Medical Care.

Author Leiyu Shi, DrPH, MBA, associate professor, Health Policy and Management, Johns Hopkins School of Public Health, said, "Simply expanding insurance coverage to previously uninsured minority patients, although helpful, may not overcome disparities in the qualitative experience of primary care among racial and ethnic groups. It is particularly crucial to identify disparities in the experience of primary care across racial and ethnic groups, since the minority population will almost equal the size of the non-Hispanic white population by the middle of the next century."

Primary care physicians are those who develop a sustained partnership with patients, address a large number of personal health care needs, and, as the point of entry into the health care system, coordinate a patient's specialist care. Past studies have shown that inferior primary care can lead to poorer health generally, reductions in the amount of preventive care received, and fragmented and uncoordinated management of medical problems. While numerous studies have indicated that minorities in the United States receive less ambulatory, hospital, and disease-specific care than whites, and experience greater barriers to interacting with the medical system, few studies have examined the qualitative experience of primary care across ethnic groups.

Dr. Shi analyzed data on all patients age 18 and over who had completed the Household Component of the 1997-98 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the U.S. civilian, noninstitutionalized population. He noted patients' race and ethnicity, experience with primary care, as well as socioeconomic variables associated with access to care, including the first contact with a provider, interpersonal treatment and trust between physician and patient, the proportion of all visits made to the same primary care physician, whether preventive services were received, and whether the physician coordinated their care with specialists. Data were obtained also on each patient's level of illness or need for care, ability to obtain services, and propensity to use medical care.

The author cautioned that since measurements of race in research are merely measures of skin color and cannot capture a person's culture, biology, values, or behavior, race may thus sometimes be used as a proxy for the influence of biological, cultural, socioeconomic, and political factors, and exposure to racism.

The results indicated that compared to whites, blacks were 1.46 and Hispanics were 1.40 times more likely to identify their usual source of care as a hospital rather than a primary care provider; that minorities waited longer to be seen during appointments than whites (21.7 to 27.7 percent of minorities waited longer than 30 minutes; 14.3 percent of whites did so); and that Asians found it most difficult to get an appointment. Whites had the best self-perceived physical and mental health status, blacks and Hispanics the worst. Hispanics were significantly less likely than whites to believe their primary physician listened to them, and Asians were less likely than whites to ask a primary care physician for a referral to a specialist. Of all groups, Asians were least satisfied with health care staff.

Ethnic differences did not, however, significantly affect whether respondents had confidence in the abilities of their primary care physician or sought prevention information or specialist referrals from him or her.

The author called for increased efforts to provide ethnically and culturally competent care and remove the many barriers facing racial and ethnic minorities in their access to primary care, including assistance in transportation and child care, expansion of office hours, and reduction in times until appointments.

The study was supported in part by the Bureau of Primary Health Care; the Health Resources and Services Administration of the U.S. Department of Health and Human Services; and the Johns Hopkins Policy Center for the Underserved.

Public Affairs Media Contacts for the Johns Hopkins Bloomberg School of Public Health: Tim Parsons or Kenna Brigham @ 410-955-6878 or