Racial and ethnic disparities in the quality of primary care for children

,

Original Research

Racial and ethnic disparities in the quality of primary care for children

J Fam Pract. 2002 June;51(6):1-1

By

Gregory D. Stevens, PhD

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References

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Address reprint requests to Gregory D. Stevens, PhD, MHS, Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, 624 N. Broadway, Rm. 661, Baltimore, MD 21205. E-mail: gstevens@jhsph.edu.

To submit a letter to the editor on this topic, click here: jfp@fammed.uc.edu.

ABSTRACT

OBJECTIVES: Healthy People 2010 calls for greater access to high-quality primary care as a means to reduce racial and ethnic disparities in children’s health. Disparities in primary care quality have rarely been studied for children, and the few studies that have been conducted among adults are not readily applicable to children because of the different health care needs of the 2 populations. This study compared the quality of primary care experienced specifically by children of different racial and ethnic groups.

STUDY DESIGN: We used a random cross-sectional community sample of children. Parents were questioned via structured telephone interview with the Primary Care Assessment Tool about a selected child’s primary care experiences. Responses were compared across racial and ethnic groups, with white children as the reference group.

POPULATION: The sample consisted of parents of 413 elementary school children, ages 5 to 12 years, enrolled in 1 school district spanning 3 suburban cities in San Bernardino County, California.

OUTCOMES MEASURED: We measured cardinal features of primary care quality including first-contact care (accessibility and utilization), longitudinality (strength of affiliation and interpersonal relationship), comprehensiveness (services offered and received), and coordination of care.

RESULTS: After controlling for family demographics, socioeconomic status, and health system characteristics, minority children experienced poorer quality of primary care across most domains of care compared with white children. Asian Americans reported the lowest quality of care across most domains, but particularly in first-contact utilization, interpersonal relationship, and comprehensiveness of services received.

CONCLUSIONS: Racial and ethnic disparities in quality persist in many aspects of primary care delivery. The findings suggested that these disparities are not simply reflections of ability to pay, health disparities, sociodemographics, or racial variations in expectations for care. The findings in this study that parents of minority children, in particular Asian Americans, report lower quality of primary care is consistent with previous research among adults but had not been demonstrated previously for children.

Key Points for Clinicians

Asian American children experience the greatest disparities in quality across most aspects of primary care delivery. Asian children had the largest deficits in seeking first-contact care from their providers, establishing effective patient-provider interpersonal relationships, and receiving the full complement of preventive services. The results suggest that racial disparities in primary care quality are not simply a reflection of ability to pay, health status disparities, or racial differences in expectations for care.
Health plans and providers should extend efforts to encourage development of a regular source of primary care for minority children, in particular Asian Americans. Delivery of high-quality primary care is particularly important for Asian American children because they are more likely to be in poor health and at greater risk for contracting certain communicable diseases than other racial groups.

Substantial disparities in children’s health and health care continue to exist across racial and ethnic groups in the United States.^1-4 With the release of Healthy People 2010, the United States has reaffirmed its commitment to eliminating these growing racial and economic disparities in children’s health. Healthy People 2010 calls for greater and more equitable delivery of high-quality primary care* and prevention to reduce these disparities. A strong primary care-oriented health care system is associated with more frequent and complete delivery of preventive services for children,^7-10 fewer complications from chronic illnesses,^11-14 and better health outcomes.^15-17

However, intensifying pressures to contain medical care costs in the US health care system have meant that even children with financial access to care are not guaranteed to receive high quality primary care. The for-profit nature of many health care delivery systems continues to raise serious concerns about quality because of the financial interest to reduce use of services. Safety-net providers such as community health centers are being forced to compete in the market-driven system and may have to compromise the quality of care they provide to vulnerable, primarily minority populations.¹⁸ Because of these concerns, consumers, providers, purchasers, and federal and state agencies are demanding better monitoring of the quality of primary care, particularly for vulnerable populations.¹⁹

Previous studies have identified significant racial and ethnic disparities in the quality of primary care among adults. Shi used nationally representative data from the Medical Expenditure Panel Survey and found that racial and ethnic minority adults experience worse primary care across most of its cardinal attributes, with the greatest differences being in the accessibility of medical care.²⁰ Murray-Garcia and colleagues²¹ also found that Asian American adults tend to report the lowest quality of primary care among racial and ethnic groups, although the results may be attributable in part to differences in patient expectations or survey response practices rather than to actual differences in quality. In 2 separate studies, Taira and colleagues^22,23 previously demonstrated similar findings regarding lower reported quality of primary care among Asian American adults. Finally, Morales et al²⁴ found that, with the exception of Asians and Pacific Islanders, there were few differences between minorities and whites in satisfaction with primary care and ratings of access and communication.