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In a Good Place: Minorities with a Medical Home Do Better

A "medical home" is more than just a regular place to go for medical treatment. It is a health care setting where patients develop relationships with their providers, working with them to maintain a healthy lifestyle and to coordinate preventive care and other ongoing health services.

According to the Commonwealth Fund report, Closing the Divide: How Medical Homes Promote Equity in Health Care (June 27), when adults have both health insurance coverage and a medical home, racial and ethnic disparities in access to care and quality of care tend to disappear. In fact, the analysis, which was based on a Fund survey of more than 2,830 adults nationwide, found that regardless of race, the vast majority of adults with a medical home always get the care they need in a timely fashion.

It Takes More Than Insurance
In 2006, nearly one-half of Hispanics and more than one of four African Americans were uninsured at some point during the year, compared with roughly one-fifth of non-Hispanic whites and Asian Americans. But while health insurance coverage is an important determinant of whether people can obtain essential care, the authors say having insurance alone cannot eliminate racial and ethnic disparities in health.

Indeed, African Americans and Hispanics are not only the groups that are least likely to have coverage, they are also the least likely to have a regular doctor or source of care. As many as 43 percent of Hispanics and 21 percent of African Americans report they have no regular doctor or source of care, compared with 15 percent of whites and 16 percent of Asian Americans.

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"Insurance coverage helps people gain access to health care, but the next thing you have to ask is, access to what?" said the report's lead author, Anne C. Beal, M.D., an assistant vice president with the Fund's Program on Quality of Care for Underserved Populations. "This survey shows if you can provide both insurance and access to a true medical home, racial and ethnic differences in getting needed medical care are often eliminated."

What Makes a Medical Home?
The report classified patients as having a medical home if they reported that they:

  • have a regular provider or place of care,
  • are able to contact a provider by phone,
  • are able to get advice or medical care on weekends or evenings, and
  • have office visits that are well organized and efficiently run.
The survey shows that nearly three-quarters of adults who have a true medical home get the care they need when they need it, compared with only 52 percent of those with a regular provider but not a medical home, and 38 percent of adults without any regular source of care.

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What most often keeps health care settings from being true medical homes is the ability to dispense medical advice or care after hours or on weekends. Only two-thirds of survey respondents who had a regular provider or source of care said it was easy for them to get care or medical advice after hours. Among all groups surveyed, Hispanics had the hardest time seeking care or advice after hours.

Community health centers and other public clinics—important providers of care for uninsured, low-income, and minority Americans—are less likely than private doctors' offices to function as medical homes for their patients, the survey found. Only 21 percent of community health centers and public clinics had all four of the indicators the survey used for identifying a medical home, compared with 32 percent of private doctors' offices.

"We know the medical home is a promising model of care for narrowing health care disparities and providing patients with much higher quality care in terms of prevention and chronic disease management," said Fund executive vice president Stephen C. Schoenbaum, M.D. "Adopting policies to encourage practitioners to embrace this model would improve care for everyone, particularly those in safety net settings."

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