August 2003

Grant Results

National Program

Changes in Health Care Financing and Organization

SUMMARY

During 1999 and 2000, Claudia L. Schur, Ph.D., and researchers at Project HOPE (Health Opportunities for People Everywhere) examined the role and implications of cultural bias in a commonly used measure of access to health care, particularly as it is applied to different subgroups of the Hispanic population.

They also replicated a previous Community Tracking Study using different access measures to demonstrate the inadequacy of the commonly used "difficulty-in-obtaining-needed-care measure." The Community Tracking Study is funded by the Robert Wood Johnson Foundation (RWJF) in its Health Tracking program.

The project was part of the Robert Wood Johnson Foundation (RWJF) Changes in Health Care Financing and Organization (HCFO) national program (for more information see Grant Results).

Key Results and Findings

  • Researchers developed an alternative to the "difficulty-in-obtaining-needed-care measure," called the "utilization-health status access measure," which evaluates actual medical care received relative to health status based on an insured population of all races.
  • While about half of uninsured non-Hispanic white respondents of the Community Tracking Survey reported barriers to medical care, only 27 percent of Hispanics interviewed in English and 17 percent interviewed in Spanish (most likely to be recent immigrants) reported barriers.
  • Application of two alternative access measures (physician visits and having a usual source of care) to a previous ranking of 12 communities resulted in quite different rankings.

Funding
RWJF supported this project through a grant of $90,313.

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THE PROJECT

Researchers at Project HOPE (a Millwood, Va.-based organization working to achieve sustainable advances in health care around the world) conducted a two-part project examining the role and implications of cultural bias in a commonly used measure of access to health care, particularly as it is applied to different subgroups of the Hispanic population.

In the first part of the project, researchers used data from the RWJF-funded Community Tracking Study to analyze the effects of Hispanic ethnicity on health care access measures. The Community Tracking Study, which is conducted by the Washington-based Center for Studying Health System Change, polls 60,000 individuals nationally — including 3,700 Hispanics — on access to medical care, satisfaction with medical care, use of services and insurance coverage.

Two questions provide data for the health care access measure, also called the "difficulty-in-obtaining-needed-care measure": whether, in the past 12 months, (1) the respondent had not gotten needed medical care at any time, and (2) there was a time when the respondent had postponed getting needed medical care. Researchers also developed an alternative access measure that would be satisfactory for measuring access by both Hispanics and non-Hispanics.

In the second part of the study, researchers evaluated community rankings of residents' ability to obtain medical care, based on different measures of access, by replicating previous RWJF-funded work by researchers at the Center for Health System Change that focused on 12 communities with populations of 200,000 or more.

The original study ranked communities based upon respondents' report of difficulty in obtaining medical care — i.e., the "difficulty-in-obtaining-needed-care measure." In the replication, researchers examined rankings using measures of physician visits and having a usual source of care.

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RESULTS

The project yielded the following results:

  • Researchers developed an alternative to the "difficulty-in-obtaining-needed-care measure," called the "utilization-health status access measure," which evaluates actual medical care received relative to health status based on an insured population of all races. Rather than evaluating a subjective response to whether someone received the care they thought they needed, the alternative measure uses data from the Community Tracking Study to examine more objective criteria — for example, how many times someone spent the night in a hospital and how often they had difficulty climbing a set of stairs.

Findings

Researchers reported the following in a Findings Brief:

  • While about half of uninsured non-Hispanic white respondents of the Community Tracking Survey reported barriers to medical care, only 27 percent of Hispanics interviewed in English and 17 percent interviewed in Spanish (most likely to be recent immigrants) reported barriers. The principal investigator noted: "Recent Hispanic immigrants … [are] less likely to have health insurance, and more reluctant to access the health care system. If an individual never uses the health care system, they do not develop any expectation of care." Thus, cultural differences in expectations can contribute to inaccurate reporting of access. The utilization-health status access measure may more accurately gauge lack of access, according to the principal investigator.
  • Application of two alternative access measures (physician visits and having a usual source of care) to a previous ranking of 12 communities resulted in quite different rankings. For example, in the original ranking, based on the difficulty-in-obtaining-needed-care measure, Newark, N.J., had the lowest percentage of people reporting difficulty accessing care, and Orange County, Calif., had the second lowest. When researchers measured these communities using the number of physician visits, however, Newark ranked eighth and Orange County twelfth and last. Researchers concluded that current community rankings might not accurately reflect access for non-English speaking Hispanics and other groups having different culturally related expectations for using health care. They suggest that the less subjective utilization-health status access measure might be more useful to policy-makers.

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GRANT DETAILS & CONTACT INFORMATION

Project

Study of Implications for Understanding Community Variation in Access to Care for Hispanics - Health Tracking Joint Solicitation

Grantee

Project Hope - People to People Health Foundation (Millwood,  VA)

  • Amount: $ 90,313
    Dates: March 1999 to November 2000
    ID#:  036333

Contact

Claudia L. Schur, Ph.D.
(301) 656-7401
cschur@projhope.org

Web Site

http://www.hcfo.net

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Report prepared by: Mary B. Geisz
Reviewed by: Robert Crum
Reviewed by: Molly McKaughan
Program Officer: Nancy L. Barrand

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