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Public Health Rep. 2005 Jul-Aug; 120(4): 431–441.
PMCID: PMC1497738

Disparities in access to care and satisfaction among U.S. children: the roles of race/ethnicity and poverty status.


OBJECTIVES: The study assessed the progress made toward reducing racial and ethnic disparities in access to health care among U.S. children between 1996 and 2000. METHODS: Data are from the Household Component of the 1996 and 2000 Medical Expenditure Panel Survey. Bivariate associations of combinations of race/ethnicity and poverty status groups were examined with four measures of access to health care and a single measure of satisfaction. Logistic regression was used to examine the association of race/ethnicity with access, controlling for sociodemographic factors associated with access to care. To highlight the role of income, we present models with and without controlling for poverty status. RESULTS: Racial and ethnic minority children experience significant deficits in accessing medical care compared with whites. Asians, Hispanics, and blacks were less likely than whites to have a usual source of care, health professional or doctor visit, and dental visit in the past year. Asians were more likely than whites to be dissatisfied with the quality of medical care in 2000 (but not 1996), while blacks and Hispanics were more likely than whites to be dissatisfied with the quality of medical care in 1996 (but not in 2000). Both before and after controlling for health insurance coverage, poverty status, health status, and several other factors associated with access to care, these disparities in access to care persisted between 1996 and 2000. CONCLUSIONS: Continued monitoring of racial and ethnic differences is necessary in light of the persistence of racial/ethnic and socioeconomic disparities in access to care. Given national goals to achieve equity in health care and eliminate racial/ ethnic disparities in health, greater attention needs to be paid to the interplay of race/ethnicity factors and poverty status in influencing access.

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Selected References

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  • Stevens Gregory D, Shi Leiyu. Racial and ethnic disparities in the primary care experiences of children: a review of the literature. Med Care Res Rev. 2003 Mar;60(1):3–30. [PubMed]
  • Halfon N, Inkelas M, Wood D. Nonfinancial barriers to care for children and youth. Annu Rev Public Health. 1995;16:447–472. [PubMed]
  • Newacheck PW. Characteristics of children with high and low usage of physician services. Med Care. 1992 Jan;30(1):30–42. [PubMed]
  • Newacheck PW, Hughes DC, Stoddard JJ. Children's access to primary care: differences by race, income, and insurance status. Pediatrics. 1996 Jan;97(1):26–32. [PubMed]
  • Orr ST, Charney E, Straus J. Use of health services by black children according to payment mechanism. Med Care. 1988 Oct;26(10):939–947. [PubMed]
  • Starfield B. Child health care and social factors: poverty, class, race. Bull N Y Acad Med. 1989 Mar;65(3):299–306. [PubMed]
  • Riley AW, Finney JW, Mellits ED, Starfield B, Kidwell S, Quaskey S, Cataldo MF, Filipp L, Shematek JP. Determinants of children's health care use: an investigation of psychosocial factors. Med Care. 1993 Sep;31(9):767–783. [PubMed]
  • Beal Anne C. Policies to reduce racial and ethnic disparities in child health and health care. Health Aff (Millwood) 2004 Sep-Oct;23(5):171–179. [PubMed]
  • Schulman KA, Rubenstein LE, Chesley FD, Eisenberg JM. The roles of race and socioeconomic factors in health services research. Health Serv Res. 1995 Apr;30(1 Pt 2):179–195. [PMC free article] [PubMed]
  • Halfon Neal, Inkelas Moira, Mistry Ritesh, Olson Lynn M. Satisfaction with health care for young children. Pediatrics. 2004 Jun;113(6 Suppl):1965–1972. [PubMed]
  • Zuckerman Barry, Stevens Gregory D, Inkelas Moira, Halfon Neal. Prevalence and correlates of high-quality basic pediatric preventive care. Pediatrics. 2004 Dec;114(6):1522–1529. [PubMed]
  • Ettner SL. The relationship between continuity of care and the health behaviors of patients: does having a usual physician make a difference? Med Care. 1999 Jun;37(6):547–555. [PubMed]
  • Strickland Bonnie, McPherson Merle, Weissman Gloria, van Dyck Peter, Huang Zhihuan J, Newacheck Paul. Access to the medical home: results of the National Survey of Children with Special Health Care Needs. Pediatrics. 2004 May;113(5 Suppl):1485–1492. [PubMed]
  • Dombkowski Kevin J, Lantz Paula M, Freed Gary L. Role of health insurance and a usual source of medical care in age-appropriate vaccination. Am J Public Health. 2004 Jun;94(6):960–966. [PubMed]
  • Jones CP, LaVeist TA, Lillie-Blanton M. "Race" in the epidemiologic literature: an examination of the American Journal of Epidemiology, 1921-1990. Am J Epidemiol. 1991 Nov 15;134(10):1079–1084. [PubMed]
  • Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995 Mar;36(1):1–10. [PubMed]
  • Racine AD, Kaestner R, Joyce TJ, Colman GJ. Differential impact of recent Medicaid expansions by race and ethnicity. Pediatrics. 2001 Nov;108(5):1135–1142. [PubMed]
  • Melnyk KA. Barriers: a critical review of recent literature. Nurs Res. 1988 Jul-Aug;37(4):196–201. [PubMed]
  • Cornelius LJ. Ethnic minorities and access to medical care: where do they stand? J Assoc Acad Minor Phys. 1993;4(1):16–25. [PubMed]
  • Flocke SA, Stange KC, Zyzanski SJ. The association of attributes of primary care with the delivery of clinical preventive services. Med Care. 1998 Aug;36(8 Suppl):AS21–AS30. [PubMed]
  • Flores Glenn. Culture, ethnicity, and linguistic issues in pediatric care: urgent priorities and unanswered questions. Ambul Pediatr. 2004 Jul-Aug;4(4):276–282. [PubMed]
  • Betancourt Joseph R, Green Alexander R, Carrillo J Emilio, Ananeh-Firempong Owusu., 2nd Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep. 2003 Jul-Aug;118(4):293–302. [PMC free article] [PubMed]
  • Brach C, Fraser I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Med Care Res Rev. 2000;57 (Suppl 1):181–217. [PMC free article] [PubMed]
  • Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR. Linking primary care performance to outcomes of care. J Fam Pract. 1998 Sep;47(3):213–220. [PubMed]
  • Starfield B, Cassady C, Nanda J, Forrest CB, Berk R. Consumer experiences and provider perceptions of the quality of primary care: implications for managed care. J Fam Pract. 1998 Mar;46(3):216–226. [PubMed]
  • LaVeist TA. Beyond dummy variables and sample selection: what health services researchers ought to know about race as a variable. Health Serv Res. 1994 Apr;29(1):1–16. [PMC free article] [PubMed]
  • Johnson KW, Anderson NB, Bastida E, Kramer BJ, Williams D, Wong M. Macrosocial and environmental influences on minority health. Health Psychol. 1995 Dec;14(7):601–612. [PubMed]

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