Racial and Ethnic Disparities Loom Large in Barriers to Timely Medical Care

Researchers find Black and Latino adults face higher barriers to timely medical care compared to White adults.

Barriers to timely medical care based on racial and ethnic disparities increased over the past two decades, according to a recent research article.

Racial and ethnic disparities impact access to healthcare. Earlier research has shown that Black and Latino people had higher lack of health insurance and cost-related unmet medical needs compared to White people from 1999 to 2018.

The recent research article, which was published by JAMA Health Forum, is based on data collected from more than 590,000 adults in the National Health Interview Survey from 1999 to 2018. The researchers examined trends in five barriers to timely medical care: inability to get through by telephone, no appointment available soon enough, long waiting times, inconvenient office or clinic hours, and lack of transportation.

The study features several key data points:

• In 1999, the percentage of people reporting any of the five barriers to timely medical care was 7.3% among the Asian group, 6.9% among the Black group, 7.9% among the Hispanic and Latino group, and 7.0% among the White group
   
• From 1999 to 2018, the percentage of adults reporting any of the five barriers to timely medical care increased for all four of the racial and ethnic groups, increasing 5.7 percentage points for Asians, 8.0 percentage points for Blacks, 8.1 percentage points for Hispanics and Latinos, and 5.9 percentage points for Whites
   
• In 2018, compared to White adults, the proportion of adults reporting any barrier was 2.1 percentage points higher for Black adults and 3.1 percentage points higher for Hispanic and Latino adults
   
• From 1999 to 2018, compared to White adults, Black adults experienced a 1.5 percentage point higher delay in care because of long waiting times at a clinic or medical office as well as 1.8 percentage point higher delay in care because of a lack of transportation
   
• From 1999 to 2018, compared to White adults, Hispanic and Latino adults experienced a 2.6 percentage point higher delay in care because of long waiting times
   
• In 2018, the overall proportion of adults reporting any barrier was 13.5%, with the adjusted prevalence among White adults at 12.9% and the proportion 2.1 percentage points higher among Black adults and 3.1 percentage points higher among Hispanic and Latino adults
   
• From 1999 to 2018, compared to uninsured White adults, disparities in any barrier to timely medical care increased 6.6 percentage points for uninsured Black adults and 5.3 percentage points for Hispanic and Latino adults
   
• In 2018, compared to White adults, the proportion of Hispanic and Latino adults who experienced a delay in care because of long waiting times was 4.0 percentage points higher
   
• In 2018, compared to White adults, the proportion of Hispanic and Latino adults who experienced a delay in care because of lack of transportation was 1.0 percentage point higher

"The findings of this serial cross-sectional study of data from the National Health Interview Survey suggest that barriers to timely medical care in the US increased for all population groups from 1999 to 2018, with associated increases in disparities among race and ethnicity groups. Interventions beyond those currently implemented are needed to improve access to medical care and to eliminate disparities among race and ethnicity groups," the study's co-authors wrote.

Interpreting the data

During the study period, barriers to timely care increased significantly, with a disparity gap between White adults and Black and Latino adults, the study's co-authors wrote. "In this nationally representative study, we found that from 1999 to 2018, the overall estimated proportion of respondents who reported barriers to timely care nearly doubled, increasing from 7.1% to 13.5%, and the increase was not proportionate across the four race and ethnicity groups. During this period, differences in accessibility and availability of care between White respondents and Black and Latino respondents increased. In 2018, Black and Latino respondents were more likely to report delayed care because of lack of transportation and long waiting times at the doctor's office compared with White respondents."

The data has three health policy implications, the study's co-authors wrote:

• "The increase in prevalence in barriers across race and ethnicity groups in the US indicates a worsening societal failure to deliver timely medical care. The fact that, overall, nearly 1 in 7 adults in 2018 experienced barriers to timely medical care indicates that attempts to improve access to care through improving access to insurance coverage alone may be inadequate—and may not be enough to reduce disparities. … Although increasing insurance coverage may address unmet medical needs by reducing cost, it is less clear that it removes barriers to timely medical care that are not directly related to cost."
   
• "The growing racial and ethnic disparities in prevalence of these barriers to timely medical care suggest that the scope of national efforts to eliminate disparities in health care access should be expanded and include societal reforms beyond the health care system. This is not to say that health care−specific interventions (eg, the [Affordable Care Act], the national Culturally and Linguistically Appropriate Services) are not fundamental toward this goal, but that eliminating disparities in these indicators requires that policy interventions address nonmedical barriers to health care access and quality, including education, housing, urban planning, employment, and transportation, which disproportionately affect underserved populations."



 
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• "There are important implications from the income- and sex-stratified findings. The finding that racial and ethnic disparities were attenuated by lower income serves as an example of the pervasiveness of income inequality in access to health care, even beyond cost-related indicators. Regarding sex, although racial and ethnic disparities among women were mostly static, they had an overall higher prevalence of barriers during the study period compared with men of the same race or ethnicity. Because women face structural challenges to accessing sex-specific primary care (eg, pregnancy, menopause, gender-sensitive care), these findings add to the evidence of a need to improve women's access to primary care throughout the different stages of the life cycle."