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Journal of General Internal Medicine

, Volume 33, Issue 10, pp 1760–1767 | Cite as

Racial Discrimination in Health Care and Utilization of Health Care: a Cross-sectional Study of California Adults

  • Héctor E. Alcalá
  • Daniel M. Cook
Original Research

Abstract

Background

Racial and ethnic discrimination in health care have been associated with suboptimal use of health care. However, limited research has examined how facets of health care utilization influence, and are influenced by, discrimination.

Objective

This study aimed to determine if type of insurance coverage and location of usual source of care used were associated with perceptions of racial or ethnic discrimination in health care. Additionally, this study examined if perceived racial or ethnic discrimination influenced delaying or forgoing prescriptions or medical care.

Design

Data from the 2015–2016 California Health Interview Survey were used. Logistic regression models estimated odds of perceiving racial or ethnic discrimination from insurance type and location of usual source of care. Logistic regression models estimated odds of delaying or forgoing medical care or prescriptions.

Participants

Responses for 39,171 adults aged 18 and over were used.

Main measures

Key health care utilization variables were as follows: current insurance coverage, location of usual source of care, delaying or forgoing medical care, and delaying or forgoing prescriptions. We examined if these effects differed by race. Ever experiencing racial or ethnic discrimination in the health care setting functioned as a dependent and independent variable in analyses.

Key results

When insurance type and location of care were included in the same model, only the former was associated with perceived discrimination. Specifically, those with Medicaid had 66% higher odds of perceiving discrimination, relative to those with employer-sponsored coverage (AOR = 1.66; 95% CI 1.11, 2.47). Race did not moderate the impact of discrimination. Perceived discrimination was associated with higher odds of delaying or forgoing both prescriptions (AOR = 1.97; 95% CI 1.26, 3.09) and medical care (AOR = 1.84; 95% CI 1.31, 2.59).

Conclusions

Health care providers have an opportunity to improve the experiences of their patients, particularly those with publicly sponsored coverage.

KEY WORDS

health insurance race discrimination health care utilization 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest..

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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  1. 1.Department of Family, Population and Preventive Medicine, Program in Public HealthStony Brook UniversityStony BrookUSA
  2. 2.School of Community Health Sciences, University of Nevada, RenoRenoUSA

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