How a patient identifies across racial and ethnic lines may be a greater indicator of their health than their insurance status, a new study suggests.
Health care disparities and access problems exist among people who get health insurance through their employer, despite arguments that access to commercial insurance acts as a great equalizer among patients, according to a study released Monday by NORC at the University of Chicago.
The report was sponsored by Morgan Health, a JPMorgan Chase & Co. initiative aimed at reforming the job-based health insurance market. The findings show that socioeconomic disparities are not the only factor leading to disparate health outcomes among different racial and ethnic groups, said Caroline Pearson, a study author and senior vice president for health strategy at NORC, a social research organization.
“When you do research and report results on race and ethnicity, inevitably someone says, ‘How much of this is due to income differences?'” Pearson said. “One of the things that was really exciting about our study was that we were able to control for differences in age, gender, income, and race and ethnicity. Health disparities persist even after these adjustments. It really suggests that health disparities are deeply rooted in our health care system.”
The researchers analyzed self-reported data from people enrolled in their employer’s health plan from 2017 to 2019. They reviewed information that 12,372 patients reported to the federal National Health Interview Survey; 3103 individuals reported to the federal National Health and Nutrition Examination Survey; and 14,580 reported to the federal National Survey on Drug Use and Health.
The study found that black, Asian, and Hispanic respondents with low-risk pregnancies were at least 3 percentage points more likely to have a C-section than their white counterparts. C-sections pose a greater risk of maternal morbidity and mortality than vaginal delivery in low-risk pregnancies and are associated with a greater risk of infection, longer hospital stays and hospital readmissions, according to the American College of Obstetricians and Gynecologists. Twenty percent of black respondents, 17.7% of Asian respondents, and 17% of Hispanic patients with low-risk births had them delivered by cesarean, compared with 13.6% of white respondents.
“These are people who are connected to the health care system and they all have low-risk pregnancies,” Pearson said. “Why are we performing C-sections at much higher rates in people of color? We shouldn’t be doing that.”
Lesbian, gay and bisexual people report higher levels of serious psychological distress, anxiety and depression than people who are heterosexual, the study said. More than 23 percent of LGBT individuals said they experienced severe psychological distress, compared to 8.8 percent of heterosexual patients who reported the condition, according to the report.
According to the report, white respondents of all genders and sexual orientations were more likely than blacks, Hispanics and Asians to experience severe psychological distress.
In the populations, 30% of people reported heavy alcohol use, 18.8% said they used illicit drugs such as cocaine, and 19.8% used tobacco products. White and Hispanic respondents reported the highest rates of heavy alcohol use, at 31.7% and 33.2%, respectively. Nearly 21 percent of white patients reported using illicit drugs, compared with 16.4 percent of blacks, 16.6 percent of Hispanics and 8.9 percent of Asians, according to the report.
Chronic disease rates also varied among black, Asian, Hispanic, and white patients.
Asians, Hispanics and blacks were more likely to have diabetes than white people, the study found. In addition, black people are more likely to have higher, uncontrolled blood pressure than white individuals.
Although nearly all respondents reported having a usual source of care, the survey showed differences in how often different racial, ethnic, and income groups use the emergency department. The study authors pointed to emergency department use as an indicator of reliable access to care.
Black patients were more likely, and Asian individuals were less likely, to visit an emergency room than white people, the researchers said. The lowest-income individuals earning less than $50,000 a year were 7.1 percentage points more likely to have visited an emergency room than the highest-income individuals earning at least $150,000.
“The working poor in this country still face a lot of challenges in terms of food security and paying medical bills versus other expenses and so on,” Pearson said. “That’s tough data for employers to digest.”
The findings create a national benchmark that employers can use to understand how the health of their workers compares to the national average, Pearson said. From there, companies should consider how to design health and wellness benefits to address health disparities, she said.
“They need to think about what are the actual things that are driving the discrepancies in this study instead of just paying for them,” Pearson said.