Study: Racial, ethnic minorities experienced more barriers to healthcare over a nearly 20-year span

Sick individuals need care and often need it in a hurry. However, it seems as if too often it’s “hurry up and wait” in the healthcare system in the U.S., according to a study in JAMA Health Forum.

What’s more, this was the case before the COVID-19 pandemic and the accompanying shortage of healthcare workers that resulted.

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. The authors concluded that “interventions beyond those currently implemented are needed to improve access to medical care and to eliminate disparities among race and ethnicity groups.”

The serial cross-sectional study reviewed survey data from 590,603 adults and found that five barriers to medical care, that aren’t related to cost, all increased. Those barriers are:

  • Inability to get through by telephone
  • No appointment available soon enough
  • Long waiting times
  • Inconvenient office or clinic hours
  • Lack of transportation

The proportion of respondents overall who reported barriers to care nearly doubled, from 7.1% to 13.5%. The study examined the impact on four racial and ethnic groups: Asians, Blacks, Hispanic/Latinos and whites. “By 2018, barrier prevalence was significantly higher among Black and Hispanic/Latino individuals who were more likely than White individuals to report experiencing long waiting times and lack of transportation,” the study found.

The authors argue their findings indicate that better insurance coverage alone might not be able to solve this problem. “Although increasing insurance coverage may address unmet medical needs by reducing cost, it is less clear that it removes barriers to timely medical care that are not directly related to cost,” the study said.

Social determinants of health can be a major hindrance for patients looking to access care in a timely manner, the researchers said.

“This is not to say that healthcare-specific interventions (eg, the ACA, the national Culturally and Linguistically Appropriate Services) are not fundamental toward this goal, but that eliminating disparities in these indicators requires that policy interventions address nonmedical barriers to healthcare access and quality, including education, housing, urban planning, employment, and transportation, which disproportionately affect underserved populations," according to the study.

In addition, the continued effects of segregation makes it more likely that Black and Latino individuals will live in medically underserved areas, and that often forces them to go to emergency departments for care that could be rendered by a primary care physician, the researchers said.

The study found that “there is a need for a multisectoral effort to improve spatial accessibility to high-quality primary care clinics and health care professionals for minoritized race and ethnicity groups. Strategies could include addressing differences in distribution of healthcare facilities, increasing flexibility of care (eg, implementing urgent clinics that do not result in discontinuity of care), including insurance coverage for nonemergency transportation to medical care, and leveraging digital health technologies for high-quality telehealth consultations that are available and accessible.”

Gender also seems to be a factor when it comes to obtaining healthcare. The study found that racial and ethnic disparities among women “were mostly static” during the study period. Nevertheless, they encountered barriers more often than the men in their racial or ethnic groups.

“Because women face structural challenges to accessing sex-specific primary care (eg, pregnancy, menopause, gender-sensitive care), these findings add to the evidence of a need to improve women’s access to primary care throughout the different stages of the life cycle,” the study said.