Study: Blacks and Latinos are more likely to forego prescriptions
As a result of a number of factors, many of them economic, working-age African-Americans and Latinos are considerably more likely than whites not to fill all of their prescriptions because of cost concerns. That’s the conclusion drawn by the Center for Studying Health System Change through an analysis of results from its Community Tracking Study 2001 Household Survey.
Overall, according to study co-author J. Lee Hargraves, about 20% of blacks, 16% of Latinos, and 11% of non-Hispanic whites did not fill at least one prescription in 2001 because of cost concerns. Mr. Hargraves tells State Health Watch the problem is of particular concern because medicine relies on Rx drugs to treat most chronic conditions. Chronic conditions contribute substantially to racial and ethnic disparities in health status in the United States, according to Mr. Hargraves, and are among the principal reasons why blacks die at a younger age and at a much higher rate than white Americans. Blacks also are more likely to have multiple chronic conditions.
More than 30% of blacks and 25% of Latinos with chronic conditions didn’t purchase all of their prescriptions in 2001 because of cost, compared with 17% of whites living with chronic conditions. Working-age Latinos and blacks without chronic conditions also were more likely than whites to face prescription drug affordability problems. In general, however, people without chronic health problems are much less likely to report having problems purchasing prescription drugs.
The study found that uninsured people were more than three times as likely as those with private health coverage to have gone without at least one prescription in 2001 because of cost concerns. But Mr. Hargraves says that earlier research by his organization has shown that drug affordability problems are not limited to the uninsured since some 25% of working-age people with Medicaid or other state coverage did not purchase at least one prescription in 2001 because they could not afford it.
Prescription drug access problems are lowest for the privately insured, regardless of race or ethnicity.
However, Mr. Hargraves says, prescription drug access problems are lowest for the privately insured, regardless of race or ethnicity. However, significant racial and ethnic disparities in access to prescription drugs exist among those with private insurance, with the largest disparities among those with chronic conditions. Working-age privately insured African-Americans with chronic conditions were twice as likely as whites (22% compared with 11%) not to purchase all of their prescription drugs in 2001 because of cost concerns. Privately insured Latinos with chronic conditions (18%) also experienced more problems affording drugs than did whites.
Mr. Hargraves tell State Health Watch that not all insurance plans are the same, and those differences in the products offered, copays, deductibles, etc. contribute to the disparities. "We didn’t think the differences would be as large as they are," he says.
Several possible explanations
According to the study, there are a number of explanations for the disparities. For example, employed blacks and Latinos generally earn less than whites, and they are less likely to work for employers offering health plans with generous prescription drug benefits. Also, if offered a choice of health plans, those employees may be more likely to select one with lower premiums, which generally would mean fewer benefits and more patient cost-sharing, to increase take-home pay.
Mr. Hargraves says that any solution to this problem will come from the ongoing debate in the country on what the nation should do about health insurance for all people.
"There’s a tension between personal responsibility and what we should do as a country," he says. "National health insurance is on the nation’s agenda again, at least through the November presidential election. There are likely to be lots of demonstration projects to try to find answers to some of the questions."
Meanwhile, another study shows that Hispanics are less likely to receive or use medications for asthma, cardiovascular disease, HIV/AIDS, mental illness, and pain. The authors say that disparities in drug treatment are substantial and often persist even after adjustments for differences in income, age, insurance coverage, and coexisting medical conditions.
Tailor prescribing to patients
That study, conducted for the National Alliance for Hispanic Health by the National Pharmaceutical Council, encourages doctors to tailor prescribing for Hispanics based on age, coexisting conditions, responsiveness to medications, and cultural perceptions of disease and treatment.
The study shows that differences among racial and ethnic groups in how medicines are metabolized have been observed and may be due to variation in genes regulating drug metabolism, environmental factors, or their interaction. Such differences, the researchers say, can result in higher or lower levels of drugs in the bloodstream.
Warranting extra attention
Based on preliminary evidence, the study cites several classes of medicines that particularly warrant extra attention. Thus, some Hispanic groups may require lower doses of antidepressants and some antipsychotic medications may be more prone to increased side effects at normal doses.
In one study, the average therapeutic dose for Hispanics was half that commonly given to whites or African-Americans. Likewise, Mexican Americans metabolize drugs regulated by the CYP2D6 gene faster than do whites, which can affect 30% of therapeutically important medications, including many cardiovascular drugs.
The study also found that language barriers and differences in cultural values can have an impact on the quality of care delivered and can negatively influence compliance, self-management, of chronic disease, and overall health outcomes for many Hispanic patients.
The study authors — Carolina Reyes, MD, assistant clinical professor at the UCLA School of Medicine; Adolph P. Falcon, director of policy for the National Alliance for Hispanic Health; and Texas Sen. Leticia Van de Putte, a pharmacist — make the following recommendations:
- Improve access to pharmaceutical therapy by making health care financing and reimbursement practices broad and flexible enough to enable rational choices of drugs, dosages, and formulations for Hispanic patients based on their genetic, medical, and cultural needs.
- Prescribe based on individual needs, so those for Hispanic populations considerations include biological, environmental, and cultural factors that can influence drug effectiveness and patient adherence to treatment regimens.
- Treat coexisting conditions common in the Hispanic population including depression paired with asthma, diabetes, or cardiovascular disease, and diabetes paired with depression.
- Meet quality standards of cultural proficiency and communication, recognizing communication barriers and cultural differences between health care providers and Hispanic patients can reduce treatment adherence and compromise overall disease management.
To try to address problems of health disparities for racial and ethnic minorities, three members of the U.S. Senate have introduced comprehensive legislation known as the "Closing the Health Care Gap Act."
Senate majority leader Bill Frist (R-TN), one of the sponsors, described the bill as "the most comprehensive national initiative to address disparities in health care access and quality."
He added there is a gap in health care today, despite strides made in recent years.
Mr. Frist pointed out that his new bill will build on legislation he and others introduced previously, the Minority Health and Health Disparities Research Education Act, which became law in November 2000.
The new bill is intended to improve overall quality of care, expand access to care, enhance research opportunities, and foster innovative outreach programs to address health care disparities. It also is said to strengthen leadership at the local and national level and promote programs to increase diversity in the health care work force.
Contact Mr. Hargraves at (202) 554-7569. To access the National Alliance study, go to: www.hispanichealth.org or www.npcnow.org; or call Sandy Welsh at the National Alliance for Hispanic Health at (202) 312-1096. For more information about the Closing the Health Care Gap Act, go to: thomas.loc.gov.