Abstract and Introduction
Abstract
Context: Access to high quality primary care was identified by Healthy People 2010 as one of the mechanisms through which racial and ethnic disparities in health might be reduced. Despite the well-established connections between good primary care and health, the scientific evidence on whether good primary care can reduce racial disparities in health is sparse.
Objective: To examine whether better primary care experience can attenuate racial and ethnic disparities in self-reported health status.
Data Sources: The 1996 to 1997 and 1998 to 1999 data from the Community Tracking Study (CTS) sponsored by the Robert Wood Johnson Foundation.
Study Design: Cross-sectional, bivariate, and multivariate analyses of inter-relationships between self-rated general and mental health status, access to and interpersonal relationship with primary care provider, and vulnerability measured by race and poverty status.
Results: We found that higher quality primary care levels are associated with reduced racial and ethnic disparities in health status, as measured by self-rated general and mental health. This relationship is particularly pronounced for the racial and ethnic minorities living at or below poverty level. Based on the data from 1996 to 1999, the study also confirmed the presence of significant and persistent health differences across racial and ethnic groups.
Conclusion: Promoting primary care may be a viable approach toward reducing racial and ethnic disparities in self-reported health status.
Introduction
Despite notable progress in the overall health of the nation, there are continuing disparities in the burden of illness and death experienced by blacks, Hispanics, Native Americans and Alaskans, and Pacific Islanders compared with the United States population as a whole and to the white population in particular. In response to the growing evidence of persistent inequalities in health, Healthy People 2010 proposed elimination of health disparities as one of its major goals and outlined potential mechanisms that can help eliminate those disparities.
One of these mechanisms is improved access to high-quality primary care. This recommendation was supported by the substantial research evidence identifying that poor access to and inferior quality of primary care could lead to reductions in the amount of preventive care, more fragmented and uncoordinated management of medical problems, and poorer health outcomes. Although the positive relationship between good primary care experience and better health outcomes has been well-established at both individual and ecological levels, few published studies exist concerning whether primary care can reduce racial and ethnic health disparities. The logic of the connection between disparity, primary care, and self-rated health is that disparity, by affecting socioeconomic and psychosocial factors, may also exacerbate some risk factors for health. Because primary care is positively related to health, it might ameliorate some of the negative health impact of disparity.
The main objective for this study was to examine the role of primary care experience in reducing racial and ethnic disparities in health status. Using 1996 to 1997 and 1998 to 1999 national data from the Community Tracking Study, this study examined two domains of primary care, accessibility and interpersonal relationship, in terms of their influences on racial/ethnic disparities in general and mental health status. The second objective for the study was to analyze the differential effect of primary care on racial and ethnic disparities by various vulnerability groups identified by the convergence of race and poverty status characteristics. Combining race and socioeconomic status into a single measure of vulnerability recognizes both the independent and congruent influence of race and socioeconomic status on health.
Findings of the study have significant policy implications by identifying whether appropriate interventions targeted at strengthening primary care and improving access to primary care are indeed effective means of reducing racial disparities in health. The evidence based on national data, and on actual individual experiences with primary care, provides more definitive conclusions about the role of primary care in reducing health disparities. In addition, examination of the relationship between vulnerability status, operationalized by racial/ethnic group membership and poverty, and health status will provide better guidance to policy makers in developing programs or interventions that address the broader risk spectrum.