Disparities/Minority Health

Disparities in outpatient care and expenditures have widened for Hispanics, but not for blacks

Disparities in outpatient care and expenditures have steadily widened for Hispanics compared with whites, while remaining relatively constant for blacks, reveals a new study. However, these disparities would have been slightly worse in 2004-2005, if socioeconomic status (SES) factors such as insurance and income, which indirectly affect access to care, had not improved for Hispanics since 1996-1997, according to calculations by Samuel H. Zuvekas, Ph.D., of the Agency for Healthcare Research and Quality (AHRQ), and colleagues. This leaves open the question of why Hispanics are faring badly compared with whites, note the researchers. Is it due to changing sociodemographics such as increased immigration of Hispanics who face language barriers to care, or is it due to changes in functioning of the health care system?

To explore trends in care disparities, they analyzed data on office-based or outpatient visits from the 1996-2005 Medical Expenditure Panel Survey (MEPS) for two time periods: 1996-1997 and 2004-2005. The researchers used the definition of racial/ethnic disparity developed by the Institute of Medicine, which adjusts for health status and takes into consideration mediation of disparities through SES factors.

The researchers found that medical care spending for whites and blacks increased significantly (over $1,500) between both periods (Figure 1). However, there was little increase (about $400) in spending on Hispanics.

When it came to having any outpatient or office-based visit in the past year, Hispanic-white disparities increased between 1996 and 2005. Black-white disparities remained relatively constant. Blacks had a 14 percent lower likelihood of making a doctor visit than whites during either time period. The disparity between blacks and whites in expenditures increased from $869 in 1996-1997 to $1,054 in 2004-2005, a difference that was not statistically significant. Hispanics were 16 percent less likely than whites to see a doctor in 1996-1997. They also had $1,011 less in expenditures compared with whites in 1996-1997, which became $1,819 less than whites by 2004-2005. This was nearly twice the black-white spending difference.

See "Measuring trends in racial/ethnic health care disparities," by Benjamin Lê Cook, PhD., M.P.H., Thomas G. McGuire, Ph.D., and Dr. Zuvekas, in the February 2009 Medical Care Research and Review 66(1), pp. 23-48. Reprints (AHRQ Publication No. 09-R019) are available from the AHRQ Publications Clearinghouse.

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