A great divide exists between the insured and the uninsured

Even as the Agency for Healthcare Research and Quality prepares to develop its first report to Congress on disparities in health care, further research links other problems in health care to these disparities.

A survey by National Public Radio (NPR), the Kaiser Family Foundation, and the Kennedy School of Government at Harvard University in Cambridge, MA, points to a significant medical divide along socioeconomic lines in America. And a national tracking study issued by the Center for Studying Health System Change finds that ethnic and racial disparities in access to medical care among uninsured working-age Americans are much greater than disparities among insured people.

Based on a nationwide telephone survey of 1,205 respondents, the NPR/Kaiser/Kennedy School research found that the vast majority of people in the top income categories have very few problems getting health care or paying for it, while in the bottom income categories many people are burdened by such problems, and that the problems are likely to be serious.

While only 20% of those surveyed say they think our health care system works pretty well, there isn’t a great push for sweeping change in the health care system.

People don’t want significant change

The survey found that most people favor current methods of providing health insurance through guaranteed benefits from employers and public programs.

Four in 10 families reported at least one problem with access to health care, paying medical bills, or perceived quality of care in the past year. The uninsured, those who earn less than $25,000 a year, and those without high school diplomas are more likely to report having health care problems. And the number of people worried about impending health care cost and access is even higher than the number actually experiencing problems.

Meanwhile, the Center for Studying Health System Change survey finds that gaps in access to medical care between uninsured Latinos and African-Americans and uninsured whites generally are almost doubled those between insured minorities and insured whites. This survey involved about 60,000 people in 33,000 families.

"Health insurance is the key that opens the door of the health care system for most working-age Americans, but especially for Latinos and African-Americans," says study author J. Lee Hargraves. For example, 31% of uninsured Latinos and 36% of uninsured African-Americans reported having a regular health care provider in 2001, compared with 51.4% of uninsured whites — an access gap of more than 20 percentage points between uninsured Latinos and uninsured whites.

Among insured people, gaps between minorities and whites still were significant, but much smaller. Thus, 67% of Latinos and 71% of African-Americans had a regular health care provider, compared with 78% of whites. Almost one in three Latinos and one in five African-Americans lacked health insurance in 2001, compared with about one in 10 white Americans.

[Access the reports at www.kff.org and www.hschange.org.]