A new survey by The Commonwealth Fund reveals that on a wide range of health care quality measures—including effective patient–physician communication, overcoming cultural and linguistic barriers, and access to health care and insurance coverage—minority Americans do not fare as well as whites. African Americans, Asian Americans, and Hispanics are more likely than whites to experience difficulty communicating with their physician, to feel that they are treated with disrespect when receiving health care, to experience barriers to access to care such as lack of insurance or not having a regular doctor, and to feel they would receive better care if they were of a different race or ethnicity. While the health care experiences of different minority groups do vary significantly, many common concerns emerge. The survey findings also frequently reveal wide variation within racial and ethnic groups.
"Communication is essential to quality medical care, and a disturbingly high proportion of patients feel that their doctors do not listen to them or report that they do not understand what their doctors say. So even when a patient reaches the doctor's office, they might not receive optimal care," said Karen Scott Collins, M.D., vice president at The Commonwealth Fund. "Physicians need support to make communication a priority, both during medical training and in practice."
Patient-Physician Communication Difficulties Are Widespread Minority Americans were more likely than whites to experience difficulty communicating with their physicians. Hispanics were more than twice as likely as whites (33% vs. 16%) to cite one or more communication problems such as not understanding the doctor, not feeling the doctor listened to them, or that they had questions for the doctor but did not ask. One-fourth of Asian Americans (27%) and African Americans (23%) experience similar communication difficulties. Fewer than half of Hispanics (45%) report it is very easy to understand information from the doctor's office, compared with three of five whites (59%). Nearly one of four adults who had visited a doctor in the last two years said there was a time when they did not follow their doctor's advice; the reasons most often given for not following a doctor's advice are disagreement with the advice (39%) and that it cost too much (27%). Among those who did not follow a doctor's advice, two of five (41%) Hispanics and nearly one of three African Americans (30%) noted that high cost was the reason for non-compliance, compared with about one of four whites (24%) and Asian Americans (27%).
Language Barriers Exist for Many Minorities For Hispanics and Asian Americans, speaking a language other than English as a primary language nearly doubles the risk of having a communication problem when receiving health care: 43% of Hispanics speaking primarily Spanish reported communication problems with their physicians, compared with 26% of Hispanics who speak primarily English. Three of five (39%) Asian Americans who are primarily non-English speaking report having a communication problem with their doctor, compared with one of four Asian Americans (25%) who speak primarily English. However, even Hispanics or Asian Americans who speak primarily English report significantly higher rates of problems communicating with their health care provider than whites.
Minority Americans More Likely to Feel Treated With Disrespect When Obtaining Health Care Minority Americans are more likely than whites to have negative experiences in the health care system. Nearly one of six African Americans (15%), one of seven Hispanics (13%), and one of ten Asian Americans (11%) feel they would receive better health care if they were of a different race or ethnicity, compared with 1% of whites. Hispanics are also twice as likely as whites to feel treated with disrespect either because of their ability to pay, ability to speak English, or because of their race or ethnicity (18% vs. 9%). Sixteen percent of African Americans felt treated with disrespect, as did 13% of Asian Americans. Hispanics (57%) and Asian Americans (54%) are less likely than African Americans (69%) or whites (72%) to say they have a great deal of confidence and trust in their doctor.
Minorities Have Worse Health Status and More Chronic Conditions Minority adults are more likely to have health problems than whites. One of five Hispanics (22%), one of six African Americans (17%), and one of six Asian Americans (17%) rate their health as fair or poor, compared with one of seven whites (14%). This difference is even more striking when taking into account that the minority population is on average younger than the white population, and would therefore be expected to be healthier. Further analysis reveals wide differences in health status within minority groups. While two of five Vietnamese American adults (40%) and three of ten Korean Americans (29%) rated their health as fair or poor, a smaller proportion of Chinese Americans (11%) said their health was fair or poor. Among adults of Hispanic origin, one of four Mexicans (25%) rated their health fair or poor, compared with one of six Puerto Ricans (16%). African Americans age 50 and older are more likely to have been diagnosed with a chronic disease or condition such as high blood pressure, heart attack, cancer, diabetes, anxiety or depression, obesity, or asthma. Three-quarters of African Americans age 50 and older (77%) have been diagnosed with one of these conditions, compared with 68% of Hispanics, 64% of whites, and 42% of Asian Americans 50 and older.
Satisfaction with Care and Preventive Care: Some Gaps Closing But Disparities Persist About two-thirds of whites (65%) and three of five African Americans (61%) report being very satisfied with their health care. Yet, just over half of Hispanics (56%) and fewer than half of Asian Americans (45%) say they are very satisfied with their care. African American and white adults are more likely to receive preventive care services than Hispanic or Asian American adults. Among those age 50 and older, 18 percent of Hispanics and 16 percent of Asian Americans said they had been screened in the past year for colon cancer, compared with 31 percent of African Americans and 28 percent of whites. Although African Americans are getting preventive services at rates at least comparable to whites, their health outcomes remain worse. Accounting for this disparity will require close examination of other points of health care delivery where problems may be occurring, such as in access to specialized care or patients' ability to carry out instructions at home.
Minority Americans Have Lower Rates of Insurance Coverage and Less Access to Care Lack of health insurance is linked to less access to care and more negative care experiences for all Americans. Hispanics and African Americans are most at risk of being uninsured. Nearly one-half of working-age Hispanics (46%) lacked health insurance for all or part of the year prior to the survey, as did one-third of African Americans. In comparison one-fifth of whites and Asian Americans ages 18-64 lacked coverage for all or part of the year. Uninsured minorities are even more likely than uninsured whites to experience problems obtaining access to health care. Uninsured minorities are more likely than uninsured whites to report little or no choice in their source of health care. Of those uninsured at any point during the year prior to the survey, two of five Hispanics (39%) and African Americans (38%) and one-third of Asian Americans (32%) said they had very little or no choice in their source of health care. In contrast, one of four uninsured whites (25%) report very little or no choice in source of care. Minority Americans, whether or not they are insured, are also more likely than whites to be disconnected from the health care system and regular sources of care, both important indicators of quality of care. Minority adults are less likely than white adults to have a regular doctor. Just over half of all Hispanics (57%) said they have a regular doctor, as did 68 percent of Asian Americans and 70 percent of African Americans. In contrast, four-fifths of whites (80%) reported having a regular doctor. African American (13%) and Hispanic adults (14%) were more than twice as likely as white adults (6%) to report no regular source of care, or that the emergency room is their usual source of care. "For almost every measure of quality there is a sharp division between the health care experiences of white and minority Americans. As our population grows more diverse, these findings send a clear warning that the health care quality divide is in danger of turning into a gulf," said Karen Davis, president of The Commonwealth Fund. "To ensure a healthy future for all, we must work to improve every quality of care measure. We should pay particular attention to those areas where minority Americans are at greatest risk, such as eliminating barriers linked to language, literacy, and lack of health insurance."