A new analysis of health care spending in the United States found stark disparities across racial and ethnic lines in how medical resources are divided.
Non-Hispanic white Americans, who made up 61 percent of the nation’s population at the time of the study, accounted for 72 percent of the $2.4 trillion spent in 2016 on ambulatory, inpatient and emergency care; nursing facilities; prescribed pharmaceuticals; and dental care, according to a recent study published in JAMA.
No other single racial or ethnic group received an outsized piece of the health care pie:
- Hispanics (then constituting 18 percent of the population) got 11 percent
- African Americans (then representing 12 percent of the population) received 11 percent
- Asian, Native Hawaiian and Pacific Islanders (then at 6 percent of the population) got 3 percent
- American Indians and Native Alaskans (then at 1 percent of the population) got 1 percent
The researchers analyzed data collected on 7.3 million health system visits, admissions or prescriptions from 2002 through 2016 totaling an estimated $29.9 trillion in spending across six types of care. The racial and ethnic disparities in health care spending that the analysis revealed persisted after adjusting for differences in age or health conditions among racial and ethnic groups.
“This study provides evidence of spending and utilization differences across race and ethnicity groups that cannot be explained by differences in the age or notified health status of the individual,” the researchers wrote.
Instead, they suggest that myriad causes that have been previously identified are at play, including “how physicians respond to patients,[…] bias that exists in the algorithms that assess health needs and determine appropriate interventions,” and “residential segregation that precludes easy access to health care services.”
Inside the numbers
Although health care spending by African Americans was roughly in proportion with their population size, the researchers say, a closer look at the numbers suggest they do not receive care until they are experiencing advanced illness.
African Americans accounted for 26 percent less spending on outpatient care but 12 percent more spending on emergency department care per person than average, a finding that “reinforces previous research showing unequal access to primary care,” the study authors observed.
In contrast, non-Hispanic white Americans received 15 percent more spending per person on outpatient care than average, suggesting they have better access to routine and preventive care. They also spend more on dental care and pharmaceuticals than other racial or ethnic groups.
“This study provides a clear picture of who is benefiting from and who is being left behind in our health care system,” lead study author Joseph L. Dieleman, an associate professor in the Department of Health Metric Sciences at the University of Washington School of Medicine, said in a statement.
Hispanics received about 33 percent less spending per person on outpatient ambulatory care than average. Asian, Native Hawaiian and Pacific Islanders received less spending per person than average on all but dental care, according to the researchers.