Q&A: Examining the context behind findings on racial, ethnic disparities in healthcare

Fierce Healthcare this week reported on a recent study in JAMA Health Forum that looks at racial and ethnic disparities that present barriers to access to healthcare for some demographic groups. Of note, those disparities existed prior to COVID-19, and not only continued through the pandemic but appear to have become more pronounced.

In the JAMA Health Forum study, researchers at Yale University used data from the National Health Interview Survey to examine barriers to care from 1999 to 2018 and found that those barriers increased for all populations during that span, but especially for racial and ethnic minorities.

One of the authors of the study is César Caraballo, M.D., a postdoctoral associate at the Yale/YNHH Center for Outcomes Research and Evaluation. In a recent email exchange, Caraballo talks about some of the implications of the findings.

César Caraballo, M.D.
(César Caraballo, M.D.)

Fierce Healthcare: What surprised you the most about the results?

César Caraballo, M.D.: The fact that the proportion of people experiencing these barriers to healthcare nearly doubled in the 20-year period was surprising. One would expect that with the increase in healthcare expenditure, there would be an accompanying increase in access. But that was not the case.

FH: Is there a possibility that the reason individuals reporting barriers to timely care between 1999 to 2018 might be because healthcare, and society in general, has become more aware and attuned to such disparities?

CC: I do not think so. The NHIS questionnaire asks for each respondent’s experience, not about disparities at large. We discover the disparities by analyzing the collective responses.

FH: Also, the study states: “The fact that, overall, nearly 1 in 7 adults in 2018 experienced barriers to timely medical care indicates that attempts to improve access to care through improving access to insurance coverage alone may be inadequate—and may not be enough to reduce disparities. We found that there was no significant trend in the racial and ethnic disparities after 2010 (when the ACA was signed into law).”

What does this mean, exactly? That the disparities that existed in 2010 essentially stayed the same until 2018? Or does the “trend” referenced refer to improvement that did not occur?

CC: This means that differences (disparities) across groups significantly increased from 1999 to 2010 but did not significantly change thereafter (2011-2018).

FH: How might providers and healthcare payers immediately begin addressing this problem? Any tips for physicians or hospitals?

CC: Some of the barriers we studied can be mitigated by quality improvement efforts at a local level, but their pervasiveness requires a major restructuring of how healt care is delivered, especially to historically minoritized racial and ethnic groups.

FH: Anything that you want to add?

CC: It is important to put our findings in context of a broader research that has shown that Black and Latino/Hispanic people have persistently higher barriers to healthcare, including affordability of care, perpetuating health disparities in the U.S.