Healthcare access disparities among Anglo, African American, and Mexican American patients in a safety-net healthcare system

Objectives and theoretical framework: The objective was to determine if healthcare access disparities exist across race and gender in a publically funded safety-net healthcare system that provides care to native-born Americans – Anglos, African Americans and Mexican Americans in Texas. Dependent variables were use of emergency departments (EDs), reported problems getting needed care, problems getting needed prescription medicines, reporting a usual source of care, and foregoing other necessities to pay for medical care. The theoretical model was the Behavioral Model for Vulnerable Populations developed by Andersen, Aday, and Gelberg. The hypothesis tested was that no healthcare disparities existed in this system. Safety-net patients should all be poor and uninsured and providers should provide healthcare equitably to all eligible citizens. Healthcare services are available to legal residents of the county with incomes up to 200% of the federal poverty level on a sliding fee scale; all other patients pay for care out-of-pocket or with insurance. Methods: Data were examined from a representative random sample of 1534 adults aged 18-64 who were patients in this safety-net system in July and August of 2000. Data were analyzed using binary logistic regression and chi-square measures of significance. Major findings: The assumptions that patients across the three ethnic groups were equivalent in terms of health status and health insurance were not confirmed. On measures of health status – overall health rating (p=.051), limited employment (p=.000), energy level (p=.001), and worry (p=.012) – Anglos reported the worst health; Mexican Americans, the best health; with African Americans intermediate. Mexican Americans were more likely to have never had health insurance, and to also have had insurance in the past year; Anglos were least likely to have ever had insurance (p=.015) or to have had insurance in the past year (p=.000). On use of EDs (p=.028), problems getting prescription medicines (p=.029), and foregoing other necessities of life to pay for healthcare, Mexican Americans were least disadvantaged with African Americans reporting greatest use of EDs among both men and women, and Anglos the most problems with prescription medicines and foregoing care, especially among women. Logistic regression revealed that health status was the strongest predictor of problems accessing healthcare in all groups; the poorer health status of safety-net patients, the more problems they had accessing care. Patterns of poor reported health status and greater problems accessing care among Anglos relative to other groups is discussed in terms of social drift and relative deprivation.