White Americans Receive Larger Share of US Health Dollars, Study Finds

Joseph Dieleman is looking to find out where the $ 3 trillion the United States spends on health care each year goes. His team’s analysis of more than a decade of data shows that a disproportionate amount of money is spent on white Americans. Additionally, research has determined that white Americans tend to receive more outpatient care, compared to other groups who tend to receive more care in emergency situations.

“Structural racism and discrimination impact access to care and the type of care received when different populations access services,” says Dieleman, associate professor in the University’s Department of Health Metrics Sciences. from Washington and lead author of the study published in JAMA Tuesday. “The types of care provided to each race or ethnicity are fundamentally different. “

That more money is being spent on white Americans than those who identify as black, Asian or Hispanic shouldn’t come as a shock given the growing body of research on health equity. But what is unique about this study is the amount of data analyzed – over 7.3 million survey responses from 2002 to 2016 – as well as the distribution by race and ethnicity in the different types of care. The researchers also explained the age differences between populations.

In 2016, the average health care expense for a white patient was $ 8,141, nearly double the average $ 4,692 spent per patient who identified as Asian, Hawaiian, or Pacific Islander. The average expense was $ 7,361 per Black patient and $ 6,025 per Hispanic patient. Whites made up 61% of the population but accounted for 72% of health spending. Hispanic patients, who made up 18% of the population, accounted for just 11% of health care spending.

Although the most recent data included in the study is from 2016, these issues are particularly relevant to the Covid-19 pandemic, as the virus has only deepened existing disparities in healthcare. Differences in hospitals where black and white patients have been admitted may explain why black Covid-19 patients are more likely to die, according to a study published in the JAMA Network Open in June. One possible reason could be that “more hospitals located in inner city areas may have poorer finances and provide poorer quality care due to differences in the makeup of payers or community resources,” the researchers suggested.

While spending for black patients was roughly equal to their 11% share of the population, the study provided insight into where they were receiving care. Black patients saw 12% more spending in the emergency room and 26% less spending on outpatient care than the average person. White patients, on the other hand, saw 15% more spending on outpatient care than the average person. Although the study did not measure the quality of care received, outpatient care generally suggests that a person receives earlier and more preventive care, rather than using the emergency room for problems that may not. not be treated and are more serious.

“We’re finding that hospital care and emergency room care are the types of care most associated with people of color,” says Dieleman. “Going forward, it appears that rapid access to high-quality primary health care is not only essential for improving health outcomes across the country, but can also lead to a more equitable distribution of health resources. . “

“Latinos and other communities of color are less likely to go to a doctor regularly and seek preventive care, and are more likely to go only when deemed necessary in such an emergency.”

Amelia Ramirez, Institute for Health Promotion Research at University of Texas Health San Antonio

While the most recent census data shows that the US population under the age of 18 is now predominantly colored, there are several big challenges. First, these communities are more likely to be uninsured, says Amelia Ramirez, who heads the Institute for Health Promotion Research at the University of Texas Health San Antonio and was not involved in the study. “In 2019, only 8% of white Americans under 64 are uninsured. But when you compare that to 11% for black Americans, 20% for Hispanics, and 22% of our Native American and Alaskan populations, those differences are significant, ”she says.

One of the key solutions is to enroll those eligible for Medicaid or refer them to the health plans available in the markets established by the Affordable Care Act. It’s a combination of lack of access and cost, Ramirez says. “Latinos and other communities of color are less likely to go to a doctor regularly and seek preventive care, and are more likely to go only when deemed necessary in such an emergency.”

It is a change that requires a change both on behalf of patients through community engagement and education on preventive care, but also on training physicians and creating a pipeline of new physicians to the within these communities. “I really think our study, while looking at health spending, is about access to primary health care,” says Dieleman.

His team plans to examine issues of geographic variation and distribution of race, ethnicity, and access at the county level, as well as updating the dataset to 2020 and the start. of the Covid-19 pandemic. The hope is that access to primary care can not only lead to better health outcomes, but also to “shift some of the spending from inpatient care and emergency department care to where the most important things are. services can actually be the most effective at preventing and managing illnesses before they get so severe.


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