Preventive Care Access and Use as a Driver of Racial and Ethnic Disparities in Medical Care

A long line of studies documents substantial racial and ethnic disparities in access and use of health care services. The 2014 National Healthcare Quality and Disparities Report found that, despite improving access through higher rates of insurance among Blacks and Hispanics in 2014, many of these racial and ethnic disparities still persist (AHRQ 2015). In aggregate, Blacks and, especially, Hispanics, are less likely to use any type of office-based or outpatient medical care, and have lower average expenditures compared to Whites (NCHS 2016; AHRQ 2015; Cook, McGuire, and Zuvekas 2009; Kirby, Taliaferro, and Zuvekas 2006).

In recent work, we extended the previous disparities literature by estimating differences in utilization across racial/ethnic groups at different levels of health rather than simply controlling for health. Specifically, we generalized the methods used by McGuire et al, Cook et al, etc. (McGuire et al. 2006; Cook, McGuire, and Zaslavsky 2012) implementing the IOM definition of health disparities, which holds that disparities are all differences in health care use except for the differences in clinical need, clinical appropriateness, and patient preferences (IOM 2003). We found that disparities in the probability of having an office-based or outpatient medical care visit are largest when adults are in excellent health, and that these disparities significantly narrow as health worsens. These wide disparities among healthy populations raise concerns of either overuse of medical care by healthy Whites or that Hispanics in particular may have inadequate access to preventive care services even if covered by insurance, or both.

In this paper, we quantify the degree to which disparities in use of care by healthy people is driven by inadequate use or access to preventive care by minority groups, as opposed to potential overutilization of preventive and non-preventive services by healthy Whites. We update our previous results using the 2010-2015 Medical Expenditure Panel Survey (MEPS), and separately estimate IOM concordant disparities among healthy adults in the use of both preventive and non-preventive ambulatory care. These results are further stratified using the MEPS questions about access to care to determine whether disparities are associated with barriers to access, or whether they represent over-utilization of different types of care.