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Racial disparities in health care utilization, the affordable care act and racial concordance preference

Author

Listed:
  • Alyson Ma

    (University of San Diego School of Business)

  • Alison Sanchez

    (University of San Diego School of Business)

  • Mindy Ma

    (Nova Southeastern University)

Abstract

The Affordable Care Act was implemented with the aim of increasing coverage and affordable access with hopes of improving health outcomes and reducing costs. Yet, disparities persist. Coverage and affordable access alone cannot explain the health care gap between racial/ethnic minorities and white patients. Instead, the focus has turned to other factors affecting utilization rates such as the patient-provider relationship. Data from nationally represented U.S. households in 2009–2017 were used to study the association between patient-provider social distance as measured by “racial/ethnic concordance” and health care utilization rates for periods covering pre- and post-ACA. Despite the reduction in financial barriers to health access with the implementation of the ACA, the correlation between racial/ethnic concordance and utilization remains positive and significant. The results suggest that while the ACA may have improved coverage and affordability, other dimensions of access, particularly acceptability, as measured by patient-provider clinical interaction experience, remains a factor in the decision to utilize care.

Suggested Citation

  • Alyson Ma & Alison Sanchez & Mindy Ma, 2022. "Racial disparities in health care utilization, the affordable care act and racial concordance preference," International Journal of Health Economics and Management, Springer, vol. 22(1), pages 91-110, March.
    • Handle: RePEc:kap:ijhcfe:v:22:y:2022:i:1:d:10.1007_s10754-021-09311-8
    DOI: 10.1007/s10754-021-09311-8
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    References listed on IDEAS

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    1. Han, X. & Call, K.T. & Pintor, J.K. & Alarcon-Espinoza, G. & Simon, A.B., 2015. "Reports of insurance-based discrimination in health care and its association with access to care," American Journal of Public Health, American Public Health Association, vol. 105, pages 517-525.
    2. Attanasio, Laura B. & Hardeman, Rachel R., 2019. "Declined care and discrimination during the childbirth hospitalization," Social Science & Medicine, Elsevier, vol. 232(C), pages 270-277.
    3. Simeonova, Emilia, 2013. "Doctors, patients and the racial mortality gap," Journal of Health Economics, Elsevier, vol. 32(5), pages 895-908.
    4. Buchmueller, T.C. & Levinson, Z.M. & Levy, H.G. & Wolfe, B.L., 2016. "Effect of the affordable care act on racial and ethnic disparities in health insurance coverage," American Journal of Public Health, American Public Health Association, vol. 106(8), pages 1416-1421.
    5. James Bailey, 2017. "Health insurance and the supply of entrepreneurs: new evidence from the affordable care act," Small Business Economics, Springer, vol. 49(3), pages 627-646, October.
    6. Balsa, Ana I. & McGuire, Thomas G., 2003. "Prejudice, clinical uncertainty and stereotyping as sources of health disparities," Journal of Health Economics, Elsevier, vol. 22(1), pages 89-116, January.
    7. Chen, J. & Bustamante, A.V. & Tom, S.E., 2015. "Health care spending and utilization by race/ethnicity under the affordable care act's dependent coverage expansion," American Journal of Public Health, American Public Health Association, vol. 105, pages 499-507.
    8. repec:nas:journl:v:115:y:2018:p:8569-8574 is not listed on IDEAS
    9. Marcella Alsan & Owen Garrick & Grant Graziani, 2019. "Does Diversity Matter for Health? Experimental Evidence from Oakland," American Economic Review, American Economic Association, vol. 109(12), pages 4071-4111, December.
    10. Hausmann, L.R. & Jeong, K. & Bost, J.E. & Kressin, N.R. & Ibrahim, S.A., 2009. "Perceived racial discrimination in health care: a comparison of Veterans Affairs and other patients," American Journal of Public Health, American Public Health Association, vol. 99, pages 718-724.
    11. Saha, S. & Arbelaez, J.J. & Cooper, L.A., 2003. "Patient-Physician Relationships and Racial Disparities in the Quality of Health Care," American Journal of Public Health, American Public Health Association, vol. 93(10), pages 1713-1719.
    12. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2017. "Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non‐Expansion States," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 36(1), pages 178-210, January.
    13. Kosali Simon & Aparna Soni & John Cawley, 2017. "The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 36(2), pages 390-417, March.
    14. Johnson, R.L. & Roter, D. & Powe, N.R. & Cooper, L.A., 2004. "Patient race/ethnicity and quality of patient-physician communication during medical visits," American Journal of Public Health, American Public Health Association, vol. 94(12), pages 2084-2090.
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    Cited by:

    1. Anderson, Ashley, 2023. "“Messengers matter”: Assessing the impact of racially concordant care on vaccine hesitation," Social Science & Medicine, Elsevier, vol. 338(C).

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