DATE : December 16, 2021
- - HISPANIC RESIDENTS IN Massachusetts have experienced some of the most significant struggles in obtaining timely, affordable health care in an appropriate setting, according to a study released Thursday by the state-run Center for Health Information and Analysis.
The study, the first in what is planned to be a series looking at equity in health care, examined access to health care and health insurance in the years before the COVID pandemic hit, in 2015 through 2019. It provides a baseline that researchers will be able to use to determine how COVID affected these issues. It concluded that Hispanic and Black residents of Massachusetts as well as those with low to moderate incomes have had the hardest time accessing care.
Huong Trieu, director of research at CHIA, said the study cannot explain why the disparities exist – those issues may be looked at in future studies focused on particular populations. But she said it is important to note the differences based on both race and income. “Despite having very high insurance rate coverage in Massachusetts and pretty strong access to health care in the Commonwealth, I think people still struggle with areas of insurance coverage, access, use, and affordability, especially through the race, ethnicity, and family income lens,” Trieu said.
Providing near-universal health insurance has been one area Massachusetts excels at since the health care reform law passed under Gov. Mitt Romney, and the report found that 93.3 percent of residents had at least 12 months of continuous health care coverage, while just 1.2 percent had no insurance over a 12-month period.
Yet among Hispanic residents, only 82 percent had continuous 12-month coverage and for poor Hispanic residents (those earning below 139 percent of the federal poverty level, a threshold that generally correlates with MassHealth eligibility), just 75 percent had at least 12 months of continuous coverage. Black residents fell in between Hispanics and Whites on both those measures.
Insurance coverage is not the only barrier to accessing care. The report found that nearly one in three Massachusetts residents had difficulty accessing care at a doctor’s office – whether because a clinic wasn’t accepting new patients, the office did not accept their insurance, or they simply could not get an appointment as soon as they felt they needed one. Again, the challenge was most severe for Hispanic patients, with 35.2 percent reporting having some difficulty accessing care, compared to 26.2 percent of non-Hispanic White residents. Black residents fell in the middle, with 31.2 percent reporting some difficulty.
There was also a correlation with income, with lower income residents more frequently reporting having trouble accessing care. But racial disparities persisted even when controlling for income. For example, 32.7 percent of the poorest White residents reported having difficulty accessing care, compared to 36.2 percent of the poorest Hispanic residents.
The report notes that this is significant because patients who have trouble getting care are more likely to forgo care and experience worsening health.
Perhaps because of these challenges, the rates of visiting a doctor or dental provider were also lower among minority and poorer residents. Minority residents were more likely than Whites to rely on the emergency room for care. According to the report, 91 percent of White residents had seen a doctor within the past year, compared to 86 percent of Blacks, and 80.8 percent of Hispanics. Conversely, 11.2 percent of Whites had used the emergency room for a non-emergency visit or had at least three ER visits in a year, compared to 20 percent of Blacks and 29.1 percent of Hispanics.
Similarly, lower income residents were less likely than higher income residents to have seen a doctor in the past year and more likely to rely on the emergency room for care. But the racial disparities persist even within income groups, with 24.4 of the lowest income Whites relying on the ER for care compared to 38.4 percent of the lowest income Hispanic residents and 27.3 percent of the lowest income Blacks.
Massachusetts has also long faced challenges in keeping health care affordable.
According to the report, Hispanics were most likely to report struggling with the cost of care. Nearly one in three Hispanic residents (32.5 percent) reported having an unmet health care need due to cost, compared to 27.3 percent of Black residents and 22.8 percent of White residents. Some of this disparity was driven by differences in income – at lower income levels, there were not significant racial disparities in the ability to afford care. But at higher income levels (over 300 percent of the federal poverty level), Hispanic residents were more likely than Whites to report not being able to afford care.
Hannah Frigand, director of the help line at Health Care for All, which helps consumers navigate health insurance, said while she had not read the study, its conclusions do not surprise her. Callers on the organization’s Spanish language call line often report difficulties getting or staying on health insurance coverage, whether because language barriers prevent them from understanding letters and forms or because they are immigrants used to the health care system in their former country. There are also fewer doctors who can serve people who do not speak English or are familiar with the cultures of immigrant communities.
“If it’s harder to navigate the health care system, often times that does result in people getting care in a more urgent state,” Frigand said.
© 2021 CommonWealth Magazine.