Do racial and ethnic disparities in health care use vary with health?

Abstract

Objective: To determine the relationship between health status and the magnitude of black-white and Hispanic-white disparities in the likelihood of having any office-based or hospital outpatient department visits, as well as number of visits.

Data source: 2010-2014 Medical Expenditure Panel Survey.

Study design: The probability of having a visit is modeled using a Probit model, and the number of visits using a negative binomial model. We use a nonlinear rank-and-replace method to adjust minority health status to be comparable to that of whites, and predict utilization at different levels of health by fixing an indicator of health status. We compare estimated differences in predicted utilization across racial/ethnic groups for each level of health status to map out the relationship between the racial/ethnic disparity and health status, also stratifying by health insurance coverage.

Extraction methods: We subset to nonelderly adults.

Principal findings: We find that Hispanic-white differences in the probability of having an office-based or hospital outpatient department were widest among adults in excellent health (27 percentage points, 95% CI: [23, 31]) and narrowest when reporting poor or fair health (15 p.p. [13, 17]). Black-white and Hispanic-white differences in the number of visits were wider for adults who report poor or fair health (5.3 visits [4.0, 6.6] and 5.7 [4.3, 7.0], respectively) compared to excellent health (1.7 [1.2, 2.1] and 1.5 [1.1, 2.0], respectively) among adults who are full-year privately insured.

Conclusions: The magnitudes of racial/ethnic disparities vary with level of health.

Keywords: health care utilization; perceived health; racial and ethnic disparities.

Figure 1

Predicted mean probability of office‐based or outpatient care during year among nonelderly adults by perceived health and insurance status [Color figure can be viewed at wileyonlinelibrary.com]

1. Notes. Data are from 2010 to 2014 Medical Expenditure Panel Survey (MEPS). Predicted means for blacks and Hispanics are estimates of the counterfactual in which each minority group has the same distribution of health characteristics as whites. Error bars represent the 95% confidence interval around each estimate. All means and standard errors are adjusted for MEPS complex survey design.

Figure 2

Predicted mean annual number of office‐based and outpatient visits among nonelderly adults by perceived health and insurance status [Color figure can be viewed at wileyonlinelibrary.com]

1. Notes. Data are from 2010‐2014 Medical Expenditure Panel Survey (MEPS). Predicted means are conditional on having any positive number of ambulatory visits. Predicted means for blacks and Hispanics are estimates of the counterfactual in which each minority group has the same distribution of health characteristics as whites. Error bars represent the 95% confidence interval around each estimate. All means and standard errors are adjusted for MEPS complex survey design.