Site of Medical Care: Do Racial and Ethnic Differences Persist?

Abstract

Prior to the 1960s, Americans generally obtained health care in racially segregated facilities or from health providers of their own race or ethnicity. Racial, geographic, and economic factors influenced where minority Americans could get their health care. Minority Americans, who were disproportionately low income, relied on a combination of sources of care, such as public hospitals and private charity care, because they were unable to afford the cost of a private doctor. Even middle-income minority Americans largely relied upon racially segregated sources of care because these were the only options available to them. In the past four decades, substantial progress has been made in reducing differences in the major sources of health care used by whites and blacks, as well as other racial/ethnic minority groups. Nonetheless, striking racial/ethnic disparities in health care use and health outcomes persist. While these disparities are well documented, factors underlying these differences are not well understood. The most frequently advanced explanations for current health care disparities focus on the characteristics of the patient (e.g., economic conditions or preferences) or the individual provider (e.g., competence or biases). However, it is conceivable that differences in the primary sources of care used by white patients and minority patients might explain some variations in the content of care. Structural or institutional factors-patient-provider relationships, referral networks, and the availability of resources such as highly trained staff and state-of-the-art technology-of varying sources of care may influence the care that patients obtain. Improving knowledge of the extent to which racial/ethnic differences persist in the site of medical care will inform future investigations of the causes of health care disparities. This study, based on original research, examines whether the major sources of ambulatory medical care of whites, African Americans, and Latinos, given similar insurance coverage, differ substantially in the United States. The intent of the study is to assess whether, at the start of the twenty-first century, race/ethnicity continues to be a primary determinant of where medical care is obtained.