Racial disparities in access to care, receipt of preventive services, and healthcare quality: How do insured Asian Americans fare?

BACKGROUND: Previous studies show that minority populations receive less adequate healthcare services than whites. Asian Americans, one of the fastest-growing groups in the US, are less well studied than other minority groups. There are few studies looking specifically at insured Asian American populations and their access to medical services, receipt of preventive screening services, and healthcare quality. METHODS: We merged data from the 2005 and 2006 Medical Expenditure Panel Survey (MEPS), a government-sponsored yearly survey of the civilian non-institutionalized US population. Our sample includes participants with health insurance - either private or public - for the entire year. We used multivariate logistic regressions to predict healthcare outcomes within the past year (or longer for certain cancer screenings) while controlling for age, gender, income, education, metropolitan statistical area, health status, source of insurance, usual source of care, and survey year. We used sample weights in order to make nationally representative estimates. RESULTS: In terms of access to care, although Asians are less likely to report they did not get care when necessary (OR 0.30, CI 0.15-0.59) or that they were delayed in getting necessary care (OR 0.52, CI 0.32-0.83), they were more likely to not have had any medical visit (OR 2.03, CI 1.70-2.42), to not have had either an outpatient or office-based visit (OR 0.52, CI 0.43-0.62) and to have problems getting care (OR 2.16, CI 1.38-3.40). In terms of preventive services among adults, Asian Americans are less likely to receive age-appropriate breast examinations (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.56-0.86) and prostate-specific antigen tests (OR 0.51, CI 0.35-0.75) than their white counterparts. Additionally, Asian American children are less likely to have their height (OR 0.35, CI 0.21-0.58) and weight measured (OR 0.28, CI 0.16-0.51), blood pressure checked (OR 0.49, CI 0.34-0.72), and have physicians discuss childhood exercise with them (OR 0.69, CI 0.48-0.99). In terms of quality of care, Asian Americans are less likely to report that the doctor explained things clearly (OR 0.56, CI 0.41-0.77), and that the doctor spent enough time with them (OR 0.61, CI 0.48-0.78). CONCLUSIONS: These data suggest that beyond the barrier of insurance coverage, there are still disparities to be addressed. For several outcomes, insured Asian Americans have significantly less access to care, less preventive care, and worse healthcare quality. Future interventions are necessary to address these existing disparities in clinic services and barriers to clinic access for Asian Americans.