Access to Care/Health Care Delivery

Racial/ethnic composition of a county can affect residents' access to care

Most studies on racial/ethnic disparities in use of care in the United States have focused on individual characteristics. However, a recent study suggests that the racial/ethnic composition of the county in which one lives may also affect his or her access to care.

The study found that 4.3 percent of blacks experienced difficulty obtaining any type of health care when they lived in a county with a high prevalence of blacks (40 percent or more) compared with 18.8 percent of blacks who found it difficult to obtain health care in low-prevalence (less than 6 percent) counties. On the other hand, blacks in high-prevalence counties reported lower rates of financial barriers (did not receive a doctor's care or prescription medication because the family needed money to buy food, clothing, or pay for housing) than blacks living in low-prevalence counties (1.6 vs. 10.5 percent).

Latinos in a county with a high prevalence of Latinos also experienced less difficulty obtaining care than Latinos in low-prevalence counties (5 percent vs. 13.4 percent), but they did not experience fewer financial barriers to care (2.2 vs. 2.4 percent). Whites who lived in counties with a high prevalence of Latinos were more likely to report difficulty obtaining care and financial barriers to care than whites living in counties with a low prevalence of Latinos (17.7 vs. 9.4 and 8.5 vs. 3.2 percent, respectively).

These differences remained after adjustment for a variety of both individual- and county-level characteristics. Thus, diminishing disparities in access to health care may require interventions that extend beyond the individual, concludes lead author, Jennifer S. Haas, M.D., M.S.P.H., of Harvard Medical School and the University of California, San Francisco. Dr. Haas and her colleagues analyzed data from the nationally representative 1996 Medical Expenditure Panel Survey of U.S. households. They correlated two measures of care access with county prevalence of blacks and Hispanics in 677 counties. This research was supported in part by the Agency for Healthcare Research and Quality (HS10771 and HS10856).

See "Variation in access to health care for different racial/ethnic groups by the racial/ethnic composition of an individual's county of residence," by Dr. Haas, Kathryn A. Phillips, Ph.D., Dean Sonneborn, M.A., and others, in the July 2004 Medical Care 42(7), pp. 707-714.

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