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IN THE ABSTRACT

STUDY AND RESULTS: Researchers from the Center for Studying Health System Change (HSC) surveyed approximately 60,000 individuals in 33,000 families to determine the frequency of doctor visits in the past year and the presence of a regular health care provider. According to this study, " ... gaps in access to medical care among working-age white Americans, African Americans and Latinos failed to improve between 1997 and 2001." Two trends were evident: from 1997 to 2001, African Americans and Latinos have less access to health care than do whites, and uninsured minorities have more difficulty obtaining care than do uninsured whites. This report uses four measures to assess access among whites, blacks and Latinos:

• Presence of a regular health care provider,
• Visit to doctor in the last year,
• Access to specialists, and
• Use of emergency room for outpatient care.

WHAT'S IMPORTANT: The presence of health insurance was responsible for a large portion of disparities in access. Uninsured minorities earn less than uninsured whites, which suggests that income also is a factor. Rising costs of health care and prescription drugs may lead to a greater number of uninsured people. If disparities between those who are uninsured compared to those insured continues and insurance coverage declines, closing the gap may continue to be a challenge for policymakers.

FIND THIS STUDY: J. Hargraves (2002) The insurance Gap and Minority Health Care, 1997-2001; Tracking Report No. 2. can be found at http://www.hschange.org

LIMITED ENGLISH PROFICIENCY

STUDY AND RESULTS: This study is based on a survey of uninsured respondents who received health care at 23 primarily safety net hospitals in 16 U.S. cities. The report compares the perceptions and experiences of adults who needed and easily got an interpreter with those who needed and did not get an interpreter (or had difficulty getting one), and with other uninsured who did not need an interpreter. Overall, the uninsured who had access to an interpreter had similar or more positive experiences at the hospital than the uninsured who had no language barrier. Adults who needed and did not get an interpreter had more negative perceptions about their health care experiences than those who did receive interpreter services or did not need them.

WHAT'S IMPORTANT: The study found that a significant portion of respondents who needed but did not get an interpreter reported leaving the hospital without understanding how to take prescribed medications. This suggests a need for improving oral and written communication about medication instructions for uninsured who have limited English proficiency. In addition, improving communication about financial information with non-English-speaking patients may benefit hospitals, as well as patients, by expanding hospitals' ability to collect some payment for services provided. Finally, the report suggests that states may want to take advantage of the federal Medicaid and SCHIP matching funds available to help health care institutions cover the cost of providing language assistance.

FIND THIS STUDY: The Access Project (April 2002), What a Difference an Interpreter Can Make: Health Care Experiences of Uninsured with Limited English Proficiency, http://www.accessproject.org/downloads/c_LEPreportENG.pdf

MENTAL HEALTH

STUDY AND RESULTS: The report, released in 2001 as a supplement to the Surgeon General's mental health report, focuses on the mental health of the four most recognized racial and ethnic minority groups in the United States-African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanic Americans (Latinos). The supplement documents the existence of disparities affecting mental health care of racial and ethnic minorities compared with whites: minorities have less access to, and availability of, mental health services; minorities are less likely to receive needed mental health services; minorities in treatment often receive a poorer quality of mental health care; and minorities are underrepresented in mental health research.

WHAT'S IMPORTANT: The report recommends improving access to treatment through increased geographic availability of mental health services, improving language access, and integrating mental health and primary care. The report highlights common barriers to receiving mental health care, such as the cost of services, the fragmented organization of services, and the societal stigma toward mental illness. Other recommendations include expanding research on racial and ethnic minority mental health, supporting mental health professionals to develop their skills in addressing minority health care, and prevention of mental illness and promotion of mental health.

FIND THIS STUDY: Office of the Surgeon General, U.S. Department of Health and Human Services (2001), Mental Health: Culture, Race and Ethnicity, A Supplement to Mental Health: A Report of the Surgeon General, http://www.surgeongeneral.gov/library/mentalhealth/cre/

NATIVE AMERICAN HEALTH

STUDY AND RESULTS: This issue brief describes the large and growing urban Indian population, their health status, and the major federal health programs and federal-state programs that are available to improve Native Americans' access to needed health services.

WHAT'S IMPORTANT: The majority of Native Americans in the United States live in American cities, not on reservations. However, federal health care policy largely focuses on the needs of those who live on reservations in rural areas. The report raises several important issues for policymakers to consider: the need for improved data on the health status of urban Indians and their access to health care; the adequacy of the Title V program for serving the health needs of urban Indians; and the changes needed in the Medicaid program to improve access of eligible urban Indians to covered services.

FIND THIS STUDY: The Henry J. Kaiser Family Foundation (November 2001), Urban Indian Health, http://www.kff.org/content/2001/6006/6006Revised.pdf

PHYSICIANS' PERSPECTIVES

STUDY AND RESULTS: This survey, conducted from March through October 2001, is based on a sample of 2,608 physicians whose primary professional activity is direct patient care. The study presents data about the following topics: perspectives of physicians on disparities in the health care system; perspectives of physicians of different racial and ethnic backgrounds; female and male physician's perspectives on disparities in the health care system; and treating gay and lesbian patients.

WHAT'S IMPORTANT: The majority of African American (77 percent) and Latino (52 percent) physicians polled say that unfair treatment based on race or ethnicity happens at least "somewhat often." A majority of all physicians, regardless of race or gender, believe that racial disparities in care do exist in terms of access to treatment for heart disease and HIV/AIDS. The study found that female and male physicians express different perspectives on disparities in care, with female physicians more likely to believe that disparities happen "very often" or "somewhat often." Overall, doctors are more likely to say that the health care system treats people unfairly "very often" or "somewhat often," based on health insurance status than on any other factor.

FIND THIS STUDY: The Henry J. Kaiser Family Foundation (March 2002), National Survey of Physicians Part I: Doctors on Disparities in Medical Care, http://www.kff.org/content/2002/20020321a/Physician_SurveyPartI_disparities.pdf

STUDY AND RESULTS: This study reports findings from the Commonwealth Fund 2001 Health Care Quality Survey. Researchers asked patients for their experiences with, and outcomes from, health care delivery in the United States. Results are broken down in the report by ethnic and racial group and into sub-groups such as national origin. The study finds some progress but notes continued gaps in how many minority group members receive care.

WHAT'S IMPORTANT: The study found that broad categories mask significant variation within Hispanic and Asian American communities. Three key concerns need to be addressed to reduce-and eventually eliminate-disparities in care: patient-doctor communication, cultural and linguistic barriers, and access to affordable health insurance. Other recommendations suggest changes in where care is given and the need for better continuity and more equal access to quality innovations. The report further suggests that a combination of language training and multi-cultural interaction training would improve patient experience and health care outcomes.

FIND THIS STUDY: Karen Scott Collins et al., Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans, The Commonwealth Fund (March 2002), http://www.cmwf.org

STUDY AND RESULTS: This benchmark report cites extensive research showing disparities in treatment-and outcome-for a host of conditions, including heart disease, cancer and HIV infection. The report moves beyond documenting disparities to weigh explanations of the differences experienced after people enter the health system. The report highlights the critical importance of patient-physician interactions in disparities, focusing on the treatment of minority patients and the outcomes of care.

WHAT'S IMPORTANT: Although much of the documented disparity is associated with socioeconomic factors, persistent differences remain even after these are adjusted for. Patient-level and system-level remedies are recommended. The study emphasizes nurturing strong and sustained patient-provider relationships, and supporting objective clinical decision-making. The 21 recommendations address legal and policy protections; health system interventions to improve communication, trust and access; patient education and empowerment; cross-cultural education for providers; data collection and monitoring; and more research.

FIND THIS STUDY: Brian D. Smedley, Adrienne Y. Stith and Alan R. Nelson, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, The Institute of Medicine (2002), http://www.iom.edu/books/030908265X/html/

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