Access to care across races: The role of discrimination

Access to care across races: The role of discrimination

Racial and ethnic disparities in access to health care have been well documented. While health insurance is a pertinent factor in improving access to medical care, there continues to be a need to understand how other factors impede or facilitate access to care. The purpose of this study is to enhance the current literature by exploring how discrimination may influence access to care using the Anderson and Aday utilization model. Data were obtained from the 2002 Florida Behavioral Risk Factor Surveillance Survey (BRFSS). Multivariate logistic regression models were conducted to assess the association between usual source of care and discrimination among 6,116 non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. Our primary independent variables of interest that were used to describe discrimination include: how often do you think about your race; when seeking health care did you feel your experiences were worse, same as, or better than others; have you felt emotionally upset as a result of how you were treated based on your race; and have you experienced physical symptoms as a result of how you were treated based on your race. In race-specific models, various discrimination variables were significantly associated with the different racial groups. Whites who experienced physical symptoms because of how they were treated based on their race (OR=0.34, 95% confidence interval CI: 0.144, 0.824) had lower odds of having a usual source of care compared to Whites who did not experience physical symptoms. Having a usual source of care was less likely among Hispanics who never thought about their race (OR=0.35, CI: 0.158, 0.779) compared to Hispanics who constantly thought about their race. Blacks that felt they were treated worse than others when seeking health care (OR=0.04, CI: 0.003, 0.797) were less likely to have a usual source of care compared to Blacks that felt they were treated better than others when seeking health care. For all races health insurance and age were significant predictors of having a usual source of care. Whites with incomes between $0-$19,000 had lower odds of having a usual source of care. Blacks with less than a high school degree were less likely to have a usual source of care. Policy makers and researchers need to broaden factors to understand how personal discrimination as well as institutional discrimination may promote or hinder continuity of care among racial groups.