Racial and Ethnic Differences in the Health of Older Americans (1997) / Chapter Skim
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6 Black-White Differences in the Use of Medical Care by the Elderly: A Contemporary Analysis
6 Black-White Differences in the Use of Medical Care by the Elderly: A Contemporary Analysis
Pages 183-209
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From page 183... ...
For instance, in 1964, white elders had 20 percent higher rates of physician visits than black elders (Davis et al., 1981; Long and Settle, 1984) , and whites were nearly twice as likely as blacks to be hospitalized (Long and Settle, 1984~.
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From page 184... ...
Failure to take a comprehensive approach may result in overlooking persistent and clinically important racial differences in medical care utilization. Second, most of the studies focus on racial differences in the quantity of medical care received by older persons (e.g., numbers of physician visits and hospital nights)
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From page 185... ...
Our study goes beyond most previous research on the elderly in two ways. First, in addition to physician visits and inpatient hospital utilization, we examine racial differences in total medical care expenditures, which serve as a rough index of the total amount of medical care received.
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From page 186... ...
Utilization of Medical Care We examine three main quantitative measures of medical care utilization during 1987: total medical care expenditures, physician visits, and inpatient hospital nights. Total medical care expenditures are defined as the sum of all expen
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From page 187... ...
Physician visits are defined as face-to-face contacts with physicians in physicians' offices, group practices, or clinics; neighborhood or family health centers; free-standing surgical centers; hospital outpatient departments; emergency rooms; or patients' homes. Inpatient hospital nights are defined as nights in acute care hospitals, excluding long-term care facilities.
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From page 188... ...
Studies of access to or demand for medical care that use multivariate analyses have found that health status is the most important determinant of medical care utilization (Manning et al., 1982; Evashwick et al., 1984; Wolinsky et al., 1989; Wan, 1982; Arling,1985~. However, most such studies of the elderly have used limited measures of health status.
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From page 189... ...
To determine the independent effect of race on medical care utilization, we conducted multivariate regression analyses with total medical care expenditures, physician visits, and inpatient hospital nights as dependent variables. Our primary analyses employed a demand-based perspective.
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From page 190... ...
Multivariate analyses were based on the two-part model of medical care utilization (Manning et al., 1981, 1987; Duan et al., 1982~. The first part of the two-part model is an equation for whether or not an individual has non-zero medical care expenditures (or physician visits or hospital nights)
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From page 191... ...
Percentages for insurance coverage add to more than 100 because some individuals had both Medicaid and private supplementary insurance in addition to Medicare.
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From page 192... ...
White elders also had more favorable indicators of physical, mental, and social health than black elders. Compared with blacks, whites had fewer functional status limitations, chronic condi TABLE 6-2 Health Status and Attitudes and Beliefs Variable Whites Blacks Health Status General health (%)
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From page 193... ...
The findings for physician visits were similar to those for total medical care expenditures. Specifically, although elderly whites and blacks had similar rates of physician visits, whites were more likely than blacks to have at least one TABLE 6-3 Medical Care Utilization Variable Whites Blacks Total medical care expenditures Mean, all individuals $4,236 $4,764 Percentage of individuals with non-zero expenditures 94.6a 88.2a Mean, individuals with non-zero expenditures $4,477b $5,401b Hospital nights Mean, all individuals 2.74 3.33 Percentage of individuals with non-zero nights 20.3 21.4 Mean, individuals with non-zero nights 13.49 15.54 Physician visits Mean, all individuals 6.64 6.41 Percentage of individuals with non-zero visits 87.9a 8 1.ga Mean, individuals with non-zero visits 7.55 7.83 ap < .01 for test of difference between whites and blacks.
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From page 194... ...
Overall, 25.9 percent of physician visits by black elders took place in hospital outpatient departments or emergency rooms, compared with 13.4 percent of physician visits by white elders. Conversely, whites saw physicians in physicians' offices, group practices, or clinics or in neighborhood or family health centers at a higher rate than blacks.
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From page 195... ...
Our primary analyses, which employed a demand-based perspective, adjusted for demographic and socioeconomic characteristics, health status, and attitudes and beliefs regarding medical care. Table 6-6 reports the results of logistic regression models for the first part of two-part models for medical care expenditures, physician visits, and hospital nights.
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From page 196... ...
0.444 (o.47) Age 80-84 Age 2 85 Female Employed Some high school High school graduate College graduate Near poor Low income Middle income High income Widowed > 1 year Divorced > 1 year Separated > 1 year Widowed or divorced < 1 year Never married Family sizef Medicare plus Medicaid Medicare plus private Uninsured .178 (0.89)
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From page 197... ...
bThe omitted category for age is 65 to 69; for educational level, no high school; for income category, poor; for marital status, married; for insurance coverage, Medicare only; for location of residence, large metropolitan area; and for general health, excellent.
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From page 198... ...
Race did not have a statistically significant independent effect on the level of medical care expenditures among users of medical care, the number of physician visits among individuals who saw a physician, or the number of hospital nights among elders who were hospitalized. Among those who spent on medical care, higher educational attainment, higher income, and having private supplementary insurance or Medicaid in addition to Medicare were associated with higher medical care expenditures, whereas female sex, a larger family, and living in a nonmetropolitan area were associated with lower expenditures.
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From page 199... ...
A stronger belief in the efficacy of self-care for health problems was associated with lower medical care expenditures and fewer physician visits and hospital nights. We also conducted secondary analyses, employing a need-based perspective, which adjusted only for age, sex, health status, and attitudes and beliefs.
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From page 200... ...
Middle income 0.118 High income Widowed > 1 year Divorced > 1 year Separated > 1 year Widowed or divorced < 1 year Never married Family sizef Medicare plus Medicaid Medicare plus private Uninsured (2.84)
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From page 201... ...
bThe omitted category for age is 65 to 69; for educational level, no high school; for income category, poor; for marital status, married; for insurance coverage, Medicare only; for location of residence, large metropolitan area; and for general health, excellent.
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From page 202... ...
These analyses found that race generally did not have statistically significant independent effects on medical care expenditures, physician visits, or hospital nights. The only exception was that black elders were slightly less likely than white elders to spend on medical care after adjustment for other demand factors, but the racial disparity in the adjusted probabilities of non-zero expenditures was very small.
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From page 203... ...
Specifically, the need-based analyses revealed that, with adjustment made for the other explanatory variables, elderly blacks were considerably less likely than elderly whites to spend on medical care or to see physicians. Moreover, among users of medical care, black elders had lower adjusted medical care expenditures than white elders, and among individuals who saw a physician, blacks had fewer physician visits than whites.
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From page 204... ...
However, there are at least three reasons why it is meaningful to ask whether the allocation of medical care services between elderly blacks and whites corresponds to observed racial differences in need. First, socioeconomic status and race are inextricably linked in American society, and race directly affects educational and economic opportunities through societal mechanisms such as stratification, segregation, and discrimination (Wallace, 1990~.
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From page 205... ...
Rather, our study focuses on the more modest goal of assessing the influence of race on medical care utilization, with health status and socioeconomic status being taken as given. Our study also is limited by imperfect measurement of health status, since it is unlikely that even our comprehensive approach captured all of the relevant racial differences in health.
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From page 206... ...
Arling, G 1985 Interaction effects in a multivariate model of physician visits by older people.
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From page 207... ...
Salvatierra 1988 Access to kidney transplantation: Has the United States eliminated income and racial differences? Archives of Internal Medicine 148:2594-2600.
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From page 208... ...
Bolick, and J Halbert 1987 Neighborhood variations in the use of city-supported primary health care services by an elderly population.
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From page 209... ...
Wallace, S.P. 1990 The political economy of health care for elderly blacks.
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