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Healthcare spending is disproportionately skewed toward white people, with less money spent on Latino patients, according to new research from the University of Washington’s Institute for Health Metrics and Evaluation and others.
“This study found statistically significant differences in estimated healthcare spending across six race/ethnicity groups, with differences present for total spending, age-standardized spending, spending by type of care, and health-condition-specific spending per notified case,” according to the study.
The disparity has significant implications for policies needed for equity in healthcare spending.
“Despite making up 18.5% of the U.S. population, only 11% of healthcare spending goes toward Latinos. We can address this disparity by examining the root cause of health care inequities and driving action to policy and system changes that support Latinos’ access to healthcare,” said Dr. Amelie Ramirez, the director of Salud America! and its home base, the Institute of Health Promotion Research at UT Health San Antonio.
Let’s learn about the data from the study, the underlying causes of disparities in healthcare spending, and how to address them.
About the Study on U.S. Healthcare Spending and Latinos
To discover disparities in healthcare spending, Dr. Joseph L. Dieleman and researchers from the UW Institute for Health Metrics and Evaluation analyzed data from 2002 to 2016 on spending for health system visits, prescriptions, ambulatory care, and emergency care.
The study showed large differences in healthcare spending by race and ethnicity:
- Latino and Asian patients received the least spending relative to their proportion of the population
- Latino patients received 11% of healthcare spending, despite accounting for 18.5% of the population
- Asian, Native Hawaiian, and Pacific Islander patients received 3% of healthcare spending, while making up 6% of the population
- White patients disproportionately benefit by receiving 72% of all healthcare spending, despite comprising only 61% of the population
- Black patients received 26% less spending on outpatient care, but 12% more on emergency department care
It’s important to note the study adjusted for age differences and disease prevalence among different groups. This means the data isn’t skewed by these variables and gives an accurate assessment of spending based on race/ethnicity.
What Drives the Inequities in Healthcare Spending among Latinos?
The large disparity in spending is due to how different racial/ethnic groups utilize healthcare.
“Non-white Americans were less likely to visit ambulatory care or receive prescriptions, and when non-white patients did access care, it was more likely to be in emergency or inpatient settings,” according to the study.
On the other hand, white patients received 15% more spending on outpatient care, meaning they have better access to routine, preventative care.
The implications of this difference are that Latinos and other people of color are less likely to regularly go to the doctor and seek preventative care and are more likely to go only when deemed truly necessary, like an emergency.
Latinos may be more hesitant to regularly go to the doctor’s office due to lack of access to culturally competent healthcare providers.
As the COVID-19 pandemic has disproportionately hospitalized Latinos, there’s been a call for more Latino healthcare workers that not only can provide bilingual services, but also make Latino patients feel more comfortable.
“We need to be culturally competent. Just because a provider may speak Spanish doesn’t mean the patient will be comfortable to talk about their pain,” said Liz Guevara, a nurse care manager at La Clinica del Pueblo, according to NBC News. “Patients are more reluctant to speak to a provider if they can’t fully express themselves.”
In addition to lacking access to competent healthcare providers, many Latinos are also uninsured.
“Lack of health insurance is a large barrier to many Latinos seeking access to healthcare,” Ramirez said. “Even though the Affordable Care Act improved Latino healthcare coverage, the uninsured rate for Latinos is still 25.1% compared to 8.5% for white adults.”
Another reason Latinos and other people of color may be discouraged from regularly going to the doctor is experiences with discrimination and implicit bias in healthcare.
Many studies have shown that physicians—especially white physicians—have implicit, subconscious preferences for white patients over patients of color.
“Implicit biases may impact the ways in which clinicians and other health care professionals diagnose and treat people of color, leading to worse outcomes,” say researchers Nao Hagiwara and Tiffany Green in Scientific American.
Thankfully, several states have moved to require implicit bias training for health care professionals in the hopes of addressing racial inequities.
In July 2020, Michigan Governor Gretchen Whitmer signed a bill to mandate implicit bias training in health care across her state. Officials in California have taken similar steps to address the disproportionate maternal mortality that Black women face. Physicians in Illinois are lobbying for a bill that would require health care professionals to take an implicit bias training course.
It’s clear that due to the structural barriers that prevent Latinos and other people of color from accessing adequate healthcare, spending is disproportionately designated to white patients.
How Can We Help Improve Healthcare for Latinos?
Researchers from the UW Institute for Health Metrics and Evaluation suggest that addressing the root causes of accessibility, insurance coverage, and implicit bias are needed to remove the disparity.
“Achieving healthcare equity will require new programs and policies to direct healthcare resources to underserved populations,” according to the study.
One major change that would help is improving health insurance coverage among Latinos.
Policy suggestions to improve health insurance coverage from nonprofit group Every Texan are:
- Ensure funding is protected for federal programs like Medicaid and CHIP
- Lower premiums and improve planes with limited benefits in private health insurance
- Remove barriers to enrolling in health insurance programs
- Provide 12 months of continuous eligibility for children on Medicaid to prevent gaps from cycling off coverage due to income changes
- Reduce medical debt by providing hospital assistance and ending surprise ambulance bills
Another major change is increasing the number of Latino healthcare workers.
That means eliminating the barriers that are preventing Latinos from going into healthcare, encouraging young Latinos to pursue careers in healthcare, and providing more scholarships for Latinos to complete their medical training.
We can also work to remove implicit biases from the doctor’s office.
You can download the free Salud America! Action Pack “Health Care Workers and Researchers: Find If You Have Implicit Bias and What to Do Next.”
“This Action Pack will help you see if you have implicit bias, learn from others who have overcome their own implicit bias, and encourage colleagues to learn about implicit bias, too,” said Ramirez, who created the Action Pack.