U.S. healthcare in black, white and shades of brown: Racial and ethnic disparities in utilization among privately insured U.S. adults

As policy makers evaluate health system reforms designed to expand health insurance coverage in the U.S., questions remain as to whether increased coverage will result in equitable, effective and efficient access to care. The objective of this study was to examine racial/ethnic inequities, or disparities, in healthcare access as measured by annual outpatient (OP) visits, charges and expenditures among U.S. adults aged 24-64 years continuously covered by private insurance. The study population included Medical Expenditure Panel Survey respondents from 2005 and 2006, classified by race (white, black, Asian/Pacific Islander) and ethnicity (non-Hispanic and Hispanic). Race and ethnicity were not mutually exclusive. Multivariate analyses were conducted using a two-part model with logistic regression to estimate unconditional outcomes (likelihood of any visits, charges or expenditures) and ordinary least squares regression to estimate conditional outcomes (amount of visits, charges or expenditures, conditional on any utilization having occurred). Relative risks (RR) by race/ethnicity were also estimated for each outcome. The study controlled for covariates including age, gender, marital status, family size, education, income, usual source of care, health status and morbidities. The results indicate that, even among adults continuously covered by private insurance during the reporting period, race/ethnicity appeared to be significantly associated with reduced probabilities of having any OP visits, charges or expenditures and with reduced amounts of OP service utilization. The findings confirm previous studies demonstrating that racial/ethnic disparities persist even among insured populations, but also indicate that insurance continuity and type (private v. public) may not sufficiently overcome racial/ethnic healthcare barriers.