When
Minority patients have insurance and a Medical
Home, their health care improves
Insurance coverage contributes to reduced racial and ethnic
health care disparities by connecting minority
patients to regular physicians
Providing minority patients a “medical home” in which they
have a regular doctor or health professional who
oversees and coordinates their care would help
eliminate racial and ethnic health disparities
and promote more health care equity, says a new
report from The Commonwealth Fund.
The report, based on a 2006 survey of more than 2,830 adults,
shows that linking minority patients with a
health care setting that offers timely,
well-organized care where they can routinely
seek physicians and medical advice can help them
better manage chronic conditions and obtain
critical preventive care services.
According to the report, Closing the Divide: How Medical
Homes Promote Equity in Health Care, in 2006
nearly one-half of Hispanics and more than one
of four African Americans were uninsured at some
point during the year. In contrast, 21 percent
of whites and 18 percent of Asian Americans
lacked coverage.
In addition to being the groups most likely to go without
health insurance, African Americans and
Hispanics are least likely to have a regular
doctor or source of care. While health
insurance coverage is an important
determinant of whether people can obtain
essential care, the authors say insurance
alone cannot eliminate racial and ethnic
disparities in health.
“Insurance coverage helps people gain access to health care,
but the next thing you have to ask is ‘access to
what"’” says lead co-author Anne Beal, M.D.,
senior program officer at the Commonwealth Fund.
“We found many disparities in care; however,
disparities are not immutable. 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,” she adds.
According to the report, patients have a medical home when
they:
Have a regular provider or place of care
Report no difficulty contacting a provider by phone
Report no difficulty getting advice or medical care when
needed on weekends or evenings
Always or often find office visits well-organized and
efficiently run
Although there are many places that are already functioning
as models of such care, what most limited a
health setting from being designated a medical
home in this survey was the ability to dispense
medical advice or care after hours or on
weekends, according to the report. Only
two-thirds of adults who have a regular provider
or source of care report that it is easy to get
care or medical advice after hours. Among all
groups surveyed, Hispanics have the hardest time
seeking care or advice after hours, and they are
least likely to have a medical home.
The survey shows that, when they have a medical home, the
vast majority of adults of all races say they
can always get the care they need when they need
it. Nearly three-quarters of adults with a
medical home report getting the care they need
compared with only 52 percent of those with a
regular provider that is not a medical home and
38 percent of adults without any regular source
of provider.
Key survey findings on the role of a medical home in
eliminating health care disparities:
Racial/Ethnic Disparities Are Still Common.
African Americans and Hispanics are less likely to be
insured, and less likely to have a regular
doctor or source of care.
Hispanics are least likely to have a medical home; only 15
percent of Hispanics report having a medical
home compared with 28 percent of whites, 34
percent of African Americans and 26 percent of
Asian Americans.
Preventive Care Is More Routine.
Minority adults with a medical home experienced no
disparities in receiving preventive care
reminders, which significantly improve rates of
routine screening for conditions such as heart
disease and cancer. For example, eight of 10
adults who received a preventive reminder had
their cholesterol checked in the past five years
compared with half of adults who did not get a
reminder.
Two-thirds (65%) of adults who have a medical home receive
preventive reminders, according to the survey.
Chronic Care is Better Managed.
Adults with a medical home are better prepared to manage
chronic conditions such as diabetes or
hypertension. Only 23 percent of adults with a
medical home report their doctor or doctor’s
office did not give them a plan to manage their
care at home compared with 65 percent who have
no regular source of care.
Forty-two percent of hypertensive adults with a medical home
report that they check their blood pressure and
it is well controlled compared with 25 percent
of those without a medical home.
Having Health Insurance Matters.
More than half of insured adults received a reminder from a
doctor’s office to schedule preventive visits
compared with only 36 percent of uninsured
adults; when African American and Hispanic
patients are insured, they are just as likely as
white adults to receive reminders to schedule
needed preventive care.
Community Health Centers and Other Public Clinics Are Important Providers of Care to Vulnerable
Patients.
Although they care for a large proportion of uninsured,
low-income, and minority adults, patients report
that community health centers (CHCs) or other
public clinics are less likely to have all four
characteristics that comprise what the survey
defined as a “medical home.” Twenty-one percent
of CHCs or public clinics have all four
indicators of a medical home, compared with 32
percent of private doctors’ offices.
The main reason CHCs and other public clinics do not function
as medical homes is because patients say they
have more difficulty getting medical advice or
care in the evenings or weekends. Since these
safety net providers play a critical role in the
care of vulnerable patients, the authors say it
is important to find ways to support CHCs and
public clinics becoming medical homes.
Promoting standards for the medical home through public
reporting of performance and rewarding providers
that meet these performance benchmarks would go
a long way toward improving the way care is
delivered and eliminating disparities, say
Commonwealth Fund authors.
“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,”
says 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,” he adds.
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Methodology
The survey was conducted by Princeton Survey Research
Associates International from May 30 through
October 19, 2006. The survey consisted of
25-minute telephone interviews in English or
Spanish among a random, nationally
representative sample of 3,535 adults at least
18 years of age living in the continental United
States. The report restricts the analysis to the
2,837 respondents ages 18-64. The sample was
designed to target African American, Hispanic,
and Asian households and it classifies adults by
insurance status and annual income. The survey
has an overall margin of sampling error of +/-
2.9 percentage points at the 95 percent
confidence level.
The Commonwealth Fund is a private foundation working toward
a high performance health system.
