Healthcare spending inequality persists, JAMA study shows
Spending for services and treatment was disproportionately higher for white people than for other racial and ethnic groups, JAMA says.
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White people account for 61% of the U.S. population but receive 72% of the care, according to a report published Tuesday by the Journal of the American Medical Association.
In comparison, Black people represent 12% of the population and account for 11% of overall health spending.
JAMA found healthcare spending for white people was higher than that of all other races and ethnicities studied. Healthcare spending per-person per-year for white people was $8,141, compared with $7,649 for American Indians and Alaska Natives, $7,361 for Black people, $6,025 for Hispanic people, and $4,692 for Asians, Native Hawaiians and Pacific Islanders.
Per-person spending was significantly greater for white individuals than the all-population mean for ambulatory care, with white individuals receiving an estimated 15% more spending on ambulatory care than the all-population mean.
Blacks spent an estimated 26% less on ambulatory care and 40% less on dental care than the all-population mean. Black individuals had 19% more spending per person on inpatient care, 12% more on emergency department care and 43% more on nursing facility care than the all-population mean spending levels.
Hispanic individuals had significantly less estimated spending per person, by an estimated 33%, relative to the all-population mean for ambulatory care. For dental care that was 29%, nursing facility care, 34%, and prescribed pharmaceuticals, 26%.
For all types of care, the differences from the all-population means were accounted for primarily by less use of services.
WHY THIS MATTERS
The JAMA study looked at healthcare spending in the United States between 2002 and 2016. It found that spending varied by race and ethnicity across different types of care, even after adjusting for age and health conditions.
Spending for routine services and treatment was disproportionately higher for white people than for other racial and ethnic groups, JAMA found.
The study included data from 7.3 million health system visits, admissions, or prescriptions.
"A disproportionately large amount of spending on white individuals existed in 2002 as well," the report noted. "These differences could not be explained simply by rates of insurance coverage."
The study's authors noted further research would be needed to assess racial disparities in healthcare and the drivers and structural forces that produce them, including spending related to the COVID-19 pandemic.
The report also suggested efforts to improve healthcare be supplemented by a focus on the multiple factors perpetuating persistent inequalities in health and health outcomes.
THE LARGER TREND
People of color in the U.S. are still facing barriers in accessing healthcare, despite the goals of legislation such as the Affordable Care Act to expand the number of insured individuals.
A Yale study published in JAMA this week found there has been little to no progress in eliminating racial and ethnic disparities in some key health indicators over the past two decades. In 2018, Black individuals with low income had the highest estimated prevalence of poor or fair health, while white individuals with middle or high income had the lowest.
In February, Blue Cross Blue Shield of Massachusetts announced a plan to address racial health inequities, an effort enabled by $350,000 Racial Equity and Justice Grants supporting minority-led not-for-profit organizations.
"Differences in access have also been explained in part by residential segregation that precludes easy access to healthcare services," the report noted. "Differences in quality of care by race and ethnicity, in part driven by the underrepresentation of some groups in the healthcare workforce, including Black and Hispanic or Latino physicians, may also contribute to hesitation in accessing care."
ON THE RECORD
"Things like insurance coverage, transportation costs and ability to take off work to access care and past experiences with the healthcare system, among other factors, impact the demand for healthcare services," study co-author Joseph Dieleman explained to news service UPI. "Policies that increase insurance coverage uptake, incentivize use of primary care and preventative services and ensure local access to essential services are important pathways for improving health and ensuring that healthcare resources are available to everyone, regardless of their race/ethnicity."
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Email the writer: nathaneddy@gmail.com
