Agency for Health Care Policy and Research · Health Care Policy and Research. It is a nationally...

Barbara L. Kass, M.P.H., C.H.E.S.

Robin M.Weinick, Ph.D.

Alan C. Monheit, Ph.D.

Health Insurance Access to Care Health Status

Medical Expenditure Panel SurveyAgency for Health Care Policy and Research

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Racial and Ethnic Differencesin Health

MEPS Chartbook No. 2 1996

Suggested citation:

Kass BL, Weinick RM, Monheit AC. Racial and ethnicdifferences in health, 1996. Rockville (MD): Agency forHealth Care Policy and Research; 1999. MEPS ChartbookNo. 2. AHCPR Pub. No. 99-0001.

i

Hispanics of all ages were the most likelyto be uninsured. Nearly 3 in 10 Hispanicchildren had no insurance coverage.

Health insurance

Hispanics were the least likely to getprivate health insurance through theirjobs. In particular, Hispanic maleworkers were far less likely than otherworkers to have job-related healthcoverage.

Blacks were less likely than whites tohave private health insurance. However,they were the group most likely to bepublicly insured.

Access to careHispanics were the least likely to have ausual source of health care.

Blacks and Hispanics were more likelythan others to have a hospital-basedusual source of care.

Families headed by Hispanics were themost likely to report barriers toobtaining the health care they needed.

Hispanics and blacks were less likelythan whites to be in excellent health andmore likely to be in fair or poor health.

Health status

Medical Expenditure Panel Survey

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This report presents estimates of health insurance coverage, access to healthcare, and health status for Hispanic, black, and white Americans. Key findingsinclude:

iii

1 Introduction

3 Source of Data for This Report

5 Section 1Health Insurance

13 Section 2Access to Health Care

19 Section 3Health Status

23 Conclusions

24 Looking AheadFuture MEPS Data

25 References

26 Notes


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Despite many recentimprovements in the health ofAmericans, substantial differencesstill exist between racial and ethnicgroups. These differences are thefocus of considerable publicattention, and in 1998 the ClintonAdministration announced a newnational effort to eliminate racialand ethnic gaps in Americans’health (the Initiative to EliminateRacial and Ethnic Disparities inHealth).

Differences in the health ofracial and ethnic groups may resultfrom differences in their experienceswith our health care system. Thisreport focuses on three key aspects

of racial and ethnic differences inhealth and health care. The firstsection presents data on the healthinsurance status of black, Hispanic,and white Americans. Since healthinsurance is just one of the factorsthat may influence racial and ethnicdifferences in health, the secondsection of the report addressesaccess to health care, described interms of usual sources of care andbarriers to care. Finally, the thirdsection turns to the motivating forcebehind our Nation’s interest in thistopic: differences in health statusamong American racial and ethnicgroups.


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Source ofData forThis

Report

The estimates presented in thisreport are drawn from the MedicalExpenditure Panel Survey (MEPS).MEPS is the third in a series ofmedical expenditure surveysconducted by the Agency forHealth Care Policy and Research. Itis a nationally representative surveythat collects detailed information onhealth status, health care use andexpenses, and health insurancecoverage of individuals and familiesin the United States.

These data come from the firstand second rounds of interviewingfor the Household Component ofthe 1996 panel of MEPS. (See Note1.) The estimates presented here are

nationally representative of thecivilian noninstitutionalizedpopulation. MEPS data are releasedto the public in a number offormats, including public use datafiles and the printed MEPS ResearchFindings and MEPS Highlightsseries. The numbers shown in thischartbook are drawn from a varietyof the Research Findings reports aswell as additional analysesconducted by the MEPS staff.Specific sources for the informationpresented here are listed in thereferences section.

In some cases, totals may notadd precisely to 100 percent as aconsequence of rounding. The racialcategory “white/other,” used insome charts, includes a number ofindividuals identified as Asians,American Indians, Aleuts, Eskimos,or other races. The health of thesegroups is of interest, but MEPSincludes too few individuals topresent data on them. Unlessotherwise noted, only differencesthat are statistically significant at the0.05 level are discussed in the text.


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HealthInsurance

Health insurance plays a criticalrole in ensuring that Americansobtain timely medical care and haveprotection against expensive healthcare costs. This section describes thehealth insurance coverage of variousracial and ethnic groups. MEPSgroups health insurance into threecategories. Those people grouped as“any private” had private healthinsurance at any time during thestudy. For example, people who hadhealth care coverage from theirworkplace for 1 month would beconsidered privately insured. Peoplewho had no private coverage at anytime during the study but who hadpublic insurance such as Medicaidor Medicare are described as “publiconly.” People who did not haveprivate or public insurance at anytime during the study are describedas “uninsured.” (See Note 1.)


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Who has coverage and who doesn’t?

Any private

Public only

Uninsured

WhiteBlackHispanic

22.5%

48.6%11.6%

33.5% 22.9%13.1%

44.0%

28.4% 75.3%

Health insurance, all ages

Black and Hispanic Americanswere more likely than whites to beuninsured. Blacks were the mostlikely to be publicly insured, whilewhites were the most likely to haveprivate coverage.

• Less than half of all Hispanicsand blacks had private healthinsurance, compared to three-fourths of whites.

• Over one-fifth of all Hispanicsand over one-fourth of blackshad only public insurance,compared to one-tenth of whites.

• Hispanics and blacks were muchmore likely than whites to beuninsured.

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Employers are the mostcommon source of private healthinsurance coverage in the UnitedStates. Overall, Hispanic and blackworkers ages 16-64 were less likelythan white workers to have job-related health insurance.

• Slightly more than half ofHispanic workers and two-thirdsof black workers had job-relatedinsurance, compared to overthree-quarters of white workers.

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Are some racial and ethnic groups morelikely to have job-related insurance?

WhiteBlackHispanic

45.1%34.0%

22.6%

54.9%

66.0% 77.4%

Do not have job-related insurance

Have job-related insurance

Job-related health insurance, workers ages 16-64

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white/other group represented morethan half of the uninsuredpopulation, Hispanics and blackswere disproportionately representedamong the uninsured.

• Hispanics represented only 11.6percent of the U.S. populationunder age 65 but accounted for21.2 percent of the uninsuredpopulation.

• Similarly, blacks represented 13.1percent of the non-elderly U.S.population but 16.9 percent ofthe uninsured population.

• In contrast, the white/othergroup represented 75.3 percentof the non-elderly U.S.population but only 61.9 percentof the uninsured population.

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Are certain racial/ethnic groups morelikely to be uninsured?

0

25

50

75

100Hispanic

Black

White/other

Uninsured populationGeneral population

75.3%

13.1%

11.6%

16.9%

61.9%

21.2%

Population under age 65

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Gender is an important factor inthe relationship betweenrace/ethnicity and health insurancecoverage.

• Private insurance coverage wassimilar for males and females ineach racial/ethnic group.

• Among all racial/ethnic groups,females were more likely thanmales to have public insurance.

• Hispanic males were substantiallymore likely to be uninsured thanany other group.

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What is the role of gender in insurancecoverage?

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20

40

60

80

100

Male

Any private

Public only

Uninsured

FemaleMaleFemaleFemale

Perc

ent

Male

37.2 29.6

19.7

43.1

25.0

25.1

50.0

21.2

75.3

47.5

12.8

31.375.3

44.9

25.5

14.4 11.9

Hispanic Black White

10.3

Health insurance, all ages

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Young adults ages 19-24 werethe age group most likely to lackhealth care coverage.

• About one-third of Hispanic andblack young men and womenhad private insurance coverage.In contrast, more than 60percent of white young adultshad such coverage.

• Among young adults, Hispanicand black women were far morelikely to be publicly insured thantheir male counterparts. Theywere also more likely than youngwhite women to have publiccoverage.

• Among young adults of bothsexes, Hispanics and blacks weremore likely than their whitecounterparts to be uninsured.

Is health insurance different for youngadults?

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20

40

60

80

100Any private

Public only

Uninsured

FemaleMaleFemaleMaleFemale

Perc

ent

Male

58.5

4.1

61.8

37.4

45.9

18.5

35.5

61.1 33.5

4.434.6

41.7 28.9

23.1

35.2

4.663.27.9

Hispanic Black White

Health insurance, ages 19-24

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Are there gender differences in job-relatedhealth insurance among racial/ethnic groups?

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• Hispanic male workers were far less likely than all other workers to have healthcoverage from an employer. Only half of Hispanic male workers obtained job-related health coverage, compared with two-thirds of black male workers andthree-quarters of white male workers.

• Hispanic female workers were much more likely than Hispanic male workers tohave job-related coverage.

• White female workers were more likely than their Hispanic or black counterpartsto have job-related health coverage.

Percent with job-related health insurance, workers ages 16-64

0

20

40

60

80

Women

Men

WhiteBlack

Perc

ent 49.7

62.466.0 66.0

76.079.1

Hispanic

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likely to be uninsured. Theywere more than twice as likely aswhite children to have noinsurance coverage.

• White children were far morelikely than either black orHispanic children to have privatehealth insurance.

• Black children were the mostlikely to have public health carecoverage (40.8 percent),followed by Hispanic (32.5percent) and white (13.1percent) children.

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Are children in certain racial/ethnic groupsmore likely to lack health insurance?

WhiteBlackHispanic

32.5% 40.8%

13.1%39.8% 41.7%

12.2%27.7%

17.6%

74.7%

Any private

Public only

Uninsured

Health insurance, children under age 18


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Access toHealth Care

Adequate access to health careservices can significantly influencehealth care use and healthoutcomes. One way to measureaccess to care is to ask whetherpeople have a usual source of care –a person or place they usually go toif they are sick or need advice abouttheir health. Lacking a usual sourceof care may also have importantimplications for the quality andcontinuity of care received. Inaddition, even people who have ausual source of care may experiencebarriers to receiving services becauseof financial or insurance restrictions,lack of availability of providers atnight or on weekends, or otherdifficulties.

This section describes racial andethnic differences in usual sources ofcare and barriers to obtainingneeded health care.

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were substantially less likely thanother Americans to have a usualsource of health care.

• Hispanics were the least likely tohave a usual source of care.

• Over three-fourths of thewhite/other group (76.3percent) had an office-basedusual source of care, comparedwith 57.9 percent of Hispanicsand 63.6 percent of blacks.

• Blacks and Hispanics were morelikely than the white/othergroup to have a hospital-basedusual source of care.

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Are different racial/ethnic groups lesslikely to have a usual source of care?

Usual source of care, all ages

Perc

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20

40

60

80

None

Hospital-based

Office-based

White/otherBlackHispanic

57.9

12.5

29.6

16.2

63.6

20.2

76.3

15.58.1

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Hispanic and black childrenwere less likely than white childrenboth to have a usual source of careand to have an office-based source ofcare.

• Hispanic children were less likelythan children in any otherracial/ethnic group to have ausual source of health care.

• Black children were twice aslikely as white children to haveno usual source of health care.

• Hispanic and black children wereless likely than white children tohave an office-based usual sourceof care and were more likely tohave a hospital-based source ofcare.

Perc

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20

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60

80

100

None

Hospital-based

Office-based

WhiteBlackHispanic

69.1

17.213.7

71.0

16.412.6

86.8

6.07.2

Usual source of care, children under age 18

Are children in some racial/ethnic groups morelikely to be without a usual source of care?

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Families headed by Hispanicswere the most likely to report havingdifficulty, delaying, or not receivinghealth care they needed.

Are certain racial/ethnic groups more likelyto face barriers to receiving health care?

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8

12

16

WhiteBlackHispanic

Perc

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15.1

9.911.4

Percent of families with barriers to obtainingneeded health care

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Among families thatencountered problems in receivingcare, those headed by Hispanics(69.1 percent) were more likely thanthose headed by persons in thewhite/other group (58.5 percent) tobe unable to afford health care.

What types of health care barriers dodifferent racial/ethnic groups experience?

Other reasons

Insurance-related reasons (See Note 2)

Unable to afford care

White/otherBlackHispanic

15.8%12.3% 20.9%

15.0%27.3% 20.6%

69.1% 60.4% 58.5%

Main problem encountered by families with barriers to care

Health Status President Clinton’s Initiative onRace calls for eliminating racial andethnic disparities in selected healthproblems by the year 2010. Asstated in the Initiative, the health ofAmericans overall has improved overthe past 5 years. However, blacksand Hispanics are still more likelythan white Americans to report thatthey have poor health.

Answers to simple questionslike the one reported here, whichasked, “Would you rate this person’shealth as excellent, very good,good, fair, or poor?” have beenshown to predict both demand formedical care services and medicaloutcomes.


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..............• Hispanics and blacks were more

likely than whites to be in fair orpoor health. Over 17 percent ofHispanics and 16 percent ofblacks were in fair or poorhealth, as compared with lessthan 10 percent of whites.

• Hispanics and blacks were lesslikely than whites to be inexcellent health.

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Does health status differ betweenracial/ethnic groups?


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40

60

80

100

Black

Fair/poor

Excellent

Very good

Good

WhiteBlack

Perc

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26.8

17.4

26.8

28.9

29.3

16.1

27.0

27.7

34.6

9.9

33.0

22.5

Hispanic

Health status, ages 18-64

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What is the role of gender in health status?

• Fair or poor health was morecommon among Hispanics andblacks than among whites forboth males and females.

• Females within each racial/ethnic group were more likelythan their male counterparts tobe in fair or poor health.

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5

10

15

20

Females

Males

WhiteBlack

Perc

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12.4

12.9 12.5

16.915.3

9.611.0

Hispanic

Percent in fair or poor health, all ages

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Are children in different racial/ethnic groupsat greater risk of being in poor health?

• Hispanic children were the mostlikely to be in fair or poor health.

• Black and Hispanic children wereless likely than white children tobe in excellent health. Just over55 percent of white childrenwere in excellent health,compared to approximately 43percent of Hispanic and 48percent of black children.

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20

40

60

80

100

Fair/poor

Excellent

Very good

Good

WhiteBlack

Perc

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42.9

22.7

26.7

7.8

48.1

21.5

26.2

4.2

55.3

13.1

28.7

2.9

BlackHispanic

Health status, children under age 18


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The data presentedin this reportsuggest thatHispanic and blackAmericans are morelikely than whiteAmericans to:

conc

lusi

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Be uninsured.

Lack a usual source of care.

Have a hospital-based usualsource of care.

These data provide a snapshotof racial and ethnic disparities in avariety of measures of health in1996. Future MEPS data can beused to follow trends in thesemeasures over time, as well as toprovide additional information onracial and ethnic disparities in health.

Be in fair or poor health.

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24 look

ing

ahea

d FutureMEPS Data

This report presents estimatesof health insurance coverage, accessto health care, and health status.Future data from MEPS will addressadditional aspects of health care,including:

• The impact of managed care.

• Use of specific services.

• Use of preventive healthservices.

• Amounts paid for health careand sources of payment.

• Additional measures of healthstatus, including healthconditions and functionallimitations.

• Amounts families pay for privatehealth insurance coverage.

MEPS is a unique data resourcefor monitoring our Nation’s healthcare system. As an ongoing survey,MEPS will produce data that can beused to examine changes over time.

references

The following references servedas source material for this chartbook.Each reference shows in parenthesesthe chartbook pages derived fromthat source.

Monheit AC, Vistnes JP. Health insurancestatus of workers and their families: 1996.Rockville (MD): Agency for Health CarePolicy and Research; 1997. MEPSResearch Findings No. 2. AHCPR Pub.No. 97-0065. (Chartbook pages 7 and11)

Vistnes JP, Monheit AC. Health insurancestatus of the civilian noninstitutionalizedpopulation: 1996. Rockville (MD):Agency for Health Care Policy andResearch; 1997. MEPS Research FindingsNo. 1. AHCPR Pub. No. 97-0030.(Chartbook pages 6, 8, 9, and 10)

Weigers M, Drilea SK. Perceived healthstatus and functional limitations amongminorities: a comparison of Hispanics,blacks, and whites. Rockville (MD):Agency for Health Care Policy andResearch; 1999 (forthcoming). MEPSResearch Findings. (Chartbook pages 20and 21)

Weinick RM, Weigers ME, Cohen JW.Children’s health insurance, access to care,and health status: new findings. HealthAffairs 1998;17:127-136. (Chartbookpages 12, 15, and 22).

Weinick RM, Zuvekas SH, Drilea SK. Accessto health care—sources and barriers, 1996.Rockville (MD): Agency for Health CarePolicy and Research; 1997. MEPSResearch Findings No. 3. AHCPR Pub.No. 98-0001. (Chartbook pages 14, 16,and 17)

Please consult the MEPS Web site at

http://www.meps.ahcpr.gov/for an updated publications list or additionalcopies of this publication. Contact the MEPS

information coordinator at AHCPR(301-594-1406) for additional information.


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Note 1: Data collection for Round 1 took place from March through July1996 and asked about health-related issues for the period fromJanuary 1, 1996, to the date of the Round 1 interview. Round 2data collection occurred during the period from August toNovember 1996 and asked survey respondents to report onhealth-related issues between the date of the first interview andthe date of the second interview. All data concerning healthinsurance, health status, and demographics presented in thischartbook come from Round 1 of the survey. Health insuranceand health status estimates should therefore be interpreted asestimates for experiences during the first half of 1996. Informationon access to care was obtained in Round 2 of the survey; however,the questions on access to care generally did not ask about aspecific time period.

Note 2: Insurance-related reasons include “insurance company wouldn’tapprove, cover, or pay for care,” “pre-existing condition,”“insurance required a referral but couldn’t get one,” and “doctorrefused to accept family’s insurance plan.”


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AHCPR Publication No. 99-0001February 1999

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