A Comparative Survey of Minority Health

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Survey Highlights

Access

Lack of insurance and lower incomes for minority adults create significant financial barriers to care.

  • Overall, 31 percent of minority Americans, ages 18-64, and 14 percent of white Americans lack health insurance, with 41 percent of Korean American, 38 percent of Hispanic American, 26 percent of African American, and 23 percent of Asian American adults uninsured.
  • Although minority adults and white adults, ages 18-64, have comparable rates of employment (72% v. 76%), minority adults are less likely than white adults to receive health insurance through their own employers (56% v. 66%).
  • Having to pay too much for medical care is reported as a major problem by more minority group members than white adults (40% v. 26%). Chinese American adults (55%) are even more likely to report health care costs as a major problem.

Choice

Minority adults have less access to regular sources of care, and less choice in where they receive care.

  • Minority adults are less likely to have a regular provider (66%), compared with 80 percent of white adults. Hispanic and Asian groups report the lowest rates of having a regular doctor or provider (58% and 60% respectively).
  • Twenty-nine percent of minority adults, compared with 16 percent of white adults report having little or no choice in where they get their health care.
  • For those with a choice of doctor, minority adults were more likely to say that the doctor's nationality, race, or ethnicity influenced their choice (12%) than white adults were (5%).
  • Overall, 25 percent of black adults see black providers; 21 percent of Hispanic American adults see Hispanic providers, and one half of Asian American adults see Asian providers.
  • Inadequate or no insurance (46%) and financial reasons (22%) were most often cited by minority adults as reasons for limited choice.Minority groups have more difficulties obtaining appropriate and needed medical care.
  • In the past year, 15 percent of minority adults did not receive needed medical care, compared with 13 percent of white adults. Puerto Rican adults comprised the largest group (24%). The cost of care and lack of insurance coverage are the two major reasons cited.
  • Paying too much for medical care is a major problem for 40 percent of minority adults, compared with 26 percent of white adults. Chinese American (53%) and Puerto Rican American (48%) adults are particularly affected.
  • Waiting too long to seek care is a major problem for 27 percent of minority adults, compared with 16 percent of white adults. This is a special problem for those of Chinese descent (46%).
  • Getting speciality care is a major problem for 18 percent of minority adults, compared with 8 percent of white adults. The problem is more acute for adults of Chinese (40%) and Puerto Rican (24%) descent.
  • Only three-quarters of minority adults speak English as their primary language. Language differences present a problem for 21 percent of minority Americans in receiving health care. Of those who do not speak English as a first language, 26 percent of Hispanic adults and 22 percent of Asian American adults need an interpreter when seeking health care services.
  • Getting a medical appointment was a major difficulty for 16 percent of minority adults, compared with 8 percent of white respondents Adults of Chinese (34%), Cuban (30%) and Puerto Rican (25%) origins were especially likely to have such problems.
  • One in twenty adults in minority groups (5%) was refused edical care, compared with 2 percent of white adults in the past year.

Quality of Care

Although minority and white adults have similar rates of utilizing care, some minority groups were more likely to receive care in a hospital emergency room, and less likely to receive important preventive services.

  • On average, white and black adults visit a doctor or medical facility five times per year, whereas Hispanic adults average four visits per year, and Asian adults average three visits per year. Among those who had been to a doctor in the past year, Puerto Rican adults (37%) were more likely than white or other minority adults to have been to the emergency room.
  • Despite similar utilization rates and poorer overall health status, minority adults who visited a doctor in the last 12 month were less likely to have been hospitalized (13%), compared with white adults (17%)
  • Of Americans who have visited a doctor in the past year, minority adults (29%) were less likely to receive preventive care services, such as blood pressure tests, Pap smears or cholesterol readings, compared with white adults (26%), particularly Vietnamese (47%), Mexican (39%), and Puerto Rican (38%) adults.Minority groups report more negative experiences with the health care system.
  • Fifteen percent of minority adults believe they would have received better care in the previous year if they were of a different race. African American (20%) and Puerto Rican (19%) adults were most likely to feel this way.
  • Almost one in ten Americans felt they were made to feel uncomfortable or treated badly when receiving health care in the prior year. For Cuban and Puerto Rican American adults, the rates were higher (19% and 14% respectively). mong minority adults who reported being treated badly, 31 percent felt such treatment was due to their race, and 48 percent felt it was due to their income levels. White Americans were most likely to attribute this to "some other reason" (30%), or to their income level (26%).
  • Adults in minority groups are also slightly less likely to feel very welcome at their doctors' offices than white adults (69% v. 75%). This was particularly true of Puerto Rican American (41%) and Chinese American (37%) adults. Crowded offices, long waits, and unfriendly staff are some of the factors that contribute to this feeling.

Satisfaction

Minority groups are less satisfied with their health care services and insurance plans.

  • Less than half (46%) of minority groups report being very satisfied with their overall health services, compared with 60 percent of white adults. Chinese (24%) and Korean (17%) adults are least likely to call their services very satisfactory.
  • Overall, minority adults assign fewer "excellent" ratings to their doctors than white adults on providing good health care overall (53% v. 58%), treating them with dignity and respect (64% v. 71%), ensuring that they understand what they have been told (58% v. 66%), listening to their health concerns and taking them seriously (56% v. 63%), and being accessible (43% v. 51%).
  • Overall, among insured adults, minority adults are about equally satisfied with their health plan or health insurance as are white adults (85% v. 83%). However, almost one in five Chinese (19%) Korean (19%), and Puerto Rican (18%) adults are very or somewhat dissatisfied with their health plans.Doctors are less trusted by minority adults, who also are more likely to use alternative medicine.
  • Minority adults are less likely than white adults to follow their doctors' orders all or most of the time (84% v. 91%).
  • Only 56 percent of white adults trust doctors very much to help with medical problems, compared with 52 percent of minority adults.
  • Alternative types of medicine were used twice as often by minority than white Americans (25% v. 14%). About one third of adults of Chinese or Korean descent used herbal medicine in the preceding year, compared with 12 percent of white adults. And one in five Koreans (22%) used acupuncture compared to one percent of all adults. However, white Americans were twice as likely to have gone to a chiropractor in the past year than minority adults (13% v. 7%).

Quality of Life Problems

Minority populations experience more stress than white adults do.

  • Minority adults report higher levels of stress than whites do. Based on indexes constructed by a variety of stress variables, 36 percent of minority adults and 26 percent of whites report "high" levels of stress¹.Chinese American and Puerto Rican adults (40%) most often report high stress.
  • Problems that were felt more strongly by minority adults than by white adults concerned problems with money (25% v. 17%); problems with spouse or partner (11% v. 6%); and their family being treated badly because of their race or cultural background (5% v. less than one-half of 1%).Violence has a bigger impact on life in minority communities.
  • Fear of crime or violence strongly affects minority adults (18%) more often than white adults (8%).
  • Knowing someone who was a victim of violence is more common for most minority adults (18% of African Americans;, 17% of Puerto Rican Americans, and 16% of Chinese Americans v. 6% each of whites and Koreans).
  • Physical assaults in the past five years were reported by 12 percent of minority adults and 9 percent of white adults.
  • Of those who are currently married or living as a couple with someone, domestic abuse was reported in the last 12 months as partner "threw something" (white adults 4% v. minority adults 6%); and "partner pushed, slapped, or hit" (white adults 3% v. minority adults 5%).
  • Sexual assaults were reported by similar percentages of white (6%) and minority (5%) adults and were less common among Asian American adults (1%).
  • Medical attention was sought by one fifth of all adults who suffered domestic or other assaults (22%). More minority adults than white adults felt they were treated with respect (88% v. 65%), and that the doctor made them feel comfortable (79% v. 64%).

Health Habits

Minority adults exercise and maintain a healthy diet less often than white adults.

  • Minority adults (26%) are more likely than white adults (20%) to report that they never exercise vigorously, or maintain a healthy diet (17% v. 11%).
  • However, cigarette-smoking is reported by more white adults (26%) than minority adults (22%). Of minority adults, men are more likely to smoke than women.
      
White adults   M (29%)   F (24%) 
 African American adults     M (26%)    F (16%)
 Hispanic adults  M (27%)    F (15%)
 Asian American adults  M (26%)    F (7%)

Health Profile

  • Minority adults are much less likely than white adults to describe their health as excellent (30% v. 41%) and more likely to describe it as fair or poor (24% v. 18%).

Demographics

Minority Americans are somewhat younger than the white population and tend to live in larger households with children. inority group members are less likely than white adults to have finished high school, and more likely to have lower incomes.

  • Almost a third (31%) of minority adults compared with 21 percent of white adults are between the ages of 18 and 29.
  • 61 percent of adults in minority groups, compared with 46 percent of white adults live in households with three or more people.
  • More than half of adults in minority groups (53%), compared with 37 percent of white adults have children under the age of 18 in the household.
  • Minority group members (24%) are twice as likely as white adults (12%) to have not finished high school.
  • Three in ten minority adults (29%), compared with one in five white adults (21%) live in households with incomes of $15,000 or less. Twenty-one percent of white adults and 15 percent of minority adults have household incomes of at least $50,000.
  • Twelve percent of minority adults are Medicaid beneficiaries, compared with 8 percent of white adults.
  • Public assistance of some kind is received by 12 percent of adults in all minority groups, compared with 6 percent of white dults.
  • Slightly fewer adults, ages 18-64, in minority groups are employed full-time (51%), compared with white adults (54%), or part-time for an employer (11% v. 9%). Minority Americans are slightly less likely than white adults to be self-employed (10% v.13%), and they are less likely to be retired (3% v. 5%)
  • Nine percent of Hispanic Americans, 8 percent of African Americans, and 5 percent of Asian Americans are unemployed, compared with 4 percent of white adults.

1The stress iindex is a weighted average of responses to the question asked about how much respondents were affected by each of eleven possible sources of stress in the last year—each response of "affected strongly" were given a value of two; "affected somewhat" was assigned a value of one; all other responses were scored as zero. To fall into the "high stress" category, a respondent had to receive more than six points. Stress variables included illness or death in the family, money or work problems, fear of crime or violence in the community, loss of job or spouse's job, problems with children, knowing someone who was a victim of violence, trouble balancing work and family demands, problems with aging parents, problem with spouse, and family mistreatment because of race or cultural background.

Publication Details

Publication Date: July 1, 1997
Citation:

A Comparative Survey of Minority Health, The Commonwealth Fund, July 1997

Related Topics
Vulnerable Populations

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