Shi Leiyu, Macinko James
Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Int J Health Serv. 2008;38(4):653-70. doi: 10.2190/HS.38.4.e.
The authors examined changes in medical care experiences of racial/ethnic groups (non-Hispanic white, Asian and Pacific Islander, Hispanic, and non-Hispanic black) between 1996 and 2002, using data from the Household Component of Medical Expenditure Panel Surveys. Proportions and adjusted odds ratios for each group's primary care experience are presented. Comparisons are made between groups at each time period and within groups between the two time periods. Multivariable analyses control for demographic and socioeconomic characteristics, health care needs and source of care, and health insurance. Racial/ethnic minorities experienced worse medical care than non-Hispanic whites, but results differed among groups. Non-Hispanic blacks were no different from non-Hispanic whites and showed a slight improvement over time, except for lower odds of having a usual source of care and worse sociodemographic and health indicators. Hispanics had worse experiences than whites in 5 of 8 indicators in 2002 (vs. 3 in 1996). Asians assessed their experience as worse than that of whites in 6 of 8 indicators in 2002 (vs. 3 in 1996), yet had higher self-rated health and education than non-Hispanic whites. Disparities in medical care experience have increased for some groups, and efforts must be made to reduce financial and nonfinancial barriers to care for racial/ethnic minority populations.
作者利用医疗支出面板调查家庭部分的数据，研究了1996年至2002年间不同种族/族裔群体（非西班牙裔白人、亚裔和太平洋岛民、西班牙裔和非西班牙裔黑人）的医疗护理体验变化。文中呈现了每组初级护理体验的比例和调整后的优势比。对每个时间段内不同组之间以及两个时间段内每组内部进行了比较。多变量分析控制了人口统计学和社会经济特征、医疗保健需求与护理来源以及医疗保险。种族/族裔少数群体的医疗护理体验比非西班牙裔白人差，但不同群体的结果有所不同。非西班牙裔黑人与非西班牙裔白人没有差异，且随着时间推移略有改善，但有常规护理来源的几率较低，社会人口统计学和健康指标较差。2002年，西班牙裔在8项指标中的5项上比白人体验更差（1996年为3项）。2002年，亚裔在8项指标中的6项上认为自己的体验比白人差（1996年为3项），但其自评健康状况和受教育程度高于非西班牙裔白人。一些群体在医疗护理体验方面的差距有所增加，必须努力减少种族/族裔少数群体获得护理的经济和非经济障碍。
