Health Care is Not Color-Blind: Race Impacts Access to Care

by Kauthar B. Umar, MA

Within the past decade, experts have made great research investments to find out if health care was indeed color blind. And, many are not too pleased with the answer. Even though we are all the same on the inside, research shows that race partially determines who has access to health care and how much care is available.

According to Dr. Vanessa Gamble, health policy consultant, member of the National Advisory Council for Healthcare Research and Quality, and author of Making A Place for Ourselves: The Black Hospital Movement, 1920-1945, disparities need to be viewed in the context of how race has been viewed historically and how it has changed.

"Race is a powerful social construct that has an impact on health outcomes," said Gamble. "There was a time in this country when people, because of the color of their skin, were not allowed in hospitals. There was a segregated hospital movement and system in the country, and for a lot of elderly African Americans, they remember it and that influences their perception of our health care system," Gamble added.

"When people were trying to desegregate hospitals they were trying to get access to care, but they were defining access to care as simply being allowed to get into the door," said Gamble. "What we have to talk about today in terms of the medical civil rights movement is what happens once you get in the door."

According to Gamble, the medical civil rights movement, originally based on a Black/White dichotomy, has changed drastically, but still continues. "Language proficiency found its way into the picture, as the U.S. became more diverse. With the ever-changing face of the nation there are still remnants of segregation in this country," she added.

Affecting Today's Community

The history of race in the U.S. and how it affects access to health care today, has been linked with a lack of financial resources as one of the many barriers to equal health care for people of color. Released in 2002, the Commonwealth Fund's 2001 Health Care Quality Survey found that Hispanics and African Americans are most at risk of being uninsured. Minorities in general have lower rates of insurance coverage and as a result, less access to health care.

"Minorities are facing different barriers today," said Dr. Jose Arbelaez, a data analyst at Johns Hopkins School of Medicine. "One of the most important [barriers] is the lack of health insurance, a big factor among African Americans and other minorities."

Dr. Arbelaez, said that rates of the uninsured and underinsured, particularly among African Americans, remain very high, affecting how care is received. A 1998-99 Allegheny County Health Department project, in collaboration with Johns Hopkins School of Medicine, explored demographics, barriers to health care, interaction with providers, and medical myths in a cross-sectional study of more than 200 community members in the Pennsylvania county.

The study found that 28.6 percent of African Americans and 13.5 percent of Whites had difficulty receiving care in the previous 12 months. African Americans were five times more likely to be asked their ability to pay for treatment, independent of their insurance status. Twenty-five percent of African Americans and 45.3 percent of Whites reported that providers made payment allowances for them, while 38.2 percent of African Americans and 22.1 percent of Whites were referred to collection agencies for medical bills.

Statistics and research show that the health care experience for Whites and people of color differ dramatically throughout the nation. According to Arbelaez, health care barriers, such as financial need, low literacy, and discrimination provide an answer to the question, is health care a color-blind process? To many, unfortunately, the answer is no.

Excerpted from the HHS Office of Minority Health Closing The Gap newsletter, August 2003.

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Published: September 15, 2005