Minorities getting less health care Attitudes, language, economic status cited as factors in study; Data collected in 1987; Report supports universal coverage as solution


African-Americans and Hispanics are least likely to get routine medical care and most likely to be without health insurance, according to a Johns Hopkins University study released today.

Because of those disparities, minorities are more likely to suffer from chronic illnesses and premature death, the report asserts.

The study, an examination of "inequities" in the health care delivery system, says that while economic status helps explain many of the disparities, other factors also contribute, including language barriers, attitudes toward health care and even geography.

The $300,000 study was commissioned by the Commonwealth Fund, a New York philanthropy, and the Joint Center for Political and Economic Studies, a Washington think tank. It is being released today on Capitol Hill at a discussion panel sponsored by U.S. Rep. Louis Stokes, D-Ohio, head of the Congressional Black Caucus' health care committee.

The study was commissioned in 1993 at a time when the country was embroiled in debate over health care reform. Even though those efforts are now largely dead, Marsha Lillie Blanton, one of the report's principal investigators, said its findings should be noted as part of the current congressional debate on the future of Medicaid.

"It's . . . critical that we make it clear where we stand and what we stand to lose or gain in the restructuring going on," said Dr. Blanton, a professor with the Johns Hopkins School of Hygiene and Public Health.

The report says the solution to the inequities would be universal health insurance. "Disparities in health coverage, use of health services, and expenditures by race/ethnicity, geographic region, and income are inexcusable in a nation with plentiful health resources," the report concludes.

Among its findings:

* About half of low-income Hispanics and African-Americans, as compared with about one-third of their white counterparts, do not visit a physician in a year.

* Low-income Hispanics and African-Americans were more likely to be uninsured if they lived in the South rather than in the Northeast.

* Those without health coverage or regular doctors were most likely to use hospital emergency rooms and outpatient clinics for routine care.

* Among families with moderate or high incomes, Hispanics and African-Americans were also less likely to have health insurance.

The study says that relatively few blacks (10 percent) and Hispanics (15 percent) see physicians of their own race, although there were indications that many more might prefer to do so.

Dr. Blanton says health care policies should build on the strengths identified by the report, for example on the comfort level between patients and physicians of the same race or ethnic group. Policies should also take advantage of community health clinics, which minorities turn to as much as they do to private physicians.

Dr. Blanton also acknowledged drawbacks in the report.

It is based on an examination of the 1987 National Medical Expenditure Survey, which sampled 15,000 households to collect data on health care use and expenditures. Not only is that information eight years old, but it was collected in a different era in regard to health care. Managed care and health maintenance organizations, now a crucial part of American care, were in their infancy when the data were gathered.

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