Despite increased access to care with the Affordable Care Act, racial inequities continue to plague healthcare settings, according to a new JAMA journal study.  The study reports that twenty years ago, “only 9 percent of white Americans rated their health as fair or poor.  But 14 percent of Hispanic Americans characterized their health in those terms, as did nearly 18 percent of Black Americans.”  Today, even though advancements have been made, the gap still exists.“The topics of racial and ethnic disparities and inequities in medicine and health care are of critical importance,” Dr. Phil B. Fontanarosa, interim editor in chief of JAMA, said, which is why its beneficial to highlight the issue in order to expand care in healthcare settings for minorities.The study authors concluded, “In a serial cross-sectional survey study of US adults from 1999 to 2018, racial and ethnic differences in self-reported health status, access, and affordability improved in some subgroups, but largely persisted.”  Despite efforts to level the playing field, there are still significant disparities.

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“We’re failing,” added Dr. Harlan Krumholz, the study’s senior author.  “If our national goals are to improve the population’s health and promote more health equity, then we have to admit that whatever we’re doing now is not doing the trick.  This should wake us up and spark us to think of new and better approaches.”One of the main issues is the inequities in access to outpatient care.  “Access to primary care physicians and specialists in the outpatient setting is really important, because they’re managing chronic conditions like diabetes, heart failure, asthma and chronic obstructive pulmonary disease,” said Kenton J. Johnston, an associate professor of health management at Saint Louis University and the lead author of the study. “If you don’t get in to see the specialist or primary care doctor, you’re going to have complications and problems downstream.”The study found that minority patients on Medicare have limited access when compared to white patients in all outpatient services.  “They are also less likely to have influenza and pneumonia vaccinations, and they have more limited access to specialists.”This has to do a lot with where services are located.  “It has more to do with the supply side,” he added. “If you want to access a good specialist, your choice of cardiologists is going to be different if you live out in the counties that are more affluent versus if you live in the poor areas.”“This is about poverty, geography and where people live and where primary care clinics are located, and it is about health insurance,” agreed Joseph Dieleman, an associate professor at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle and an author of the study. “It is also about people’s past experiences with the health care system and the quality of care they or their loved ones have received, which leads to hesitation or resistance to accessing health care early.”The pandemic has illuminated these racial gaps with coronavirus mortality rates much higher in minority populations than in their white counterparts.  Healthcare settings, and the hospital system in general, the study notes, has a long history of racism. “Ending structural racism and inequities in the U.S. health care system has proved to be a challenge,” the authors wrote.

Sources:

Racial Inequities Persist in Health Care Despite Expanded InsuranceTrends in Differences in Health Status and Health Care Access and Affordability by Race and Ethnicity in the United States, 1999-2018