Two new studies published Tuesday show White people dominate health care spending across the United States, despite decades of efforts to equalize health care access.
The studies, published in the Journal of the American Medical Association, show per-person health care spending increased with age for every racial and ethnic group, but White individuals spent the most per-person than any other group.
For one study, a team at the Institute for Health Metrics and Evaluation at the University of Washington’s School of Medicine examined breakdowns of health care spending covering 7.3 million visits, hospital admission and prescriptions between 2002 and 2016. They found that in 2016, Whites accounted for 72% of the estimated $2.4 trillion in health care spending, while only making up 61% of the US population. In the same year, Black individuals made up 12% of the population but accounted for 11% of spending, and Hispanic individuals made up 18% of the population and but received 11% of total spending.
American Indian, Native Hawaiian, and Pacific Islander individuals made up 6% of the population and accounted for an estimated 3% of health care spending, and American Indian and Alaska Native individuals made up 1% of the population, and received 1% of health care spending.
White people spent an estimated $8,941 per person on health care in 2016, the team found. This is around double of the estimated per-person spending of both Hispanic and Asian, Native Hawaiian, and Pacific Islander individuals.
“White individuals received an estimated 15% more spending on ambulatory (outpatient) care than the all-population mean,” the team wrote. Black people received 26% less spending than the all-population mean on ambulatory care but received 19% more on inpatient and 12% more on emergency department care, they added. “Hispanic individuals received an estimated 33% less spending per person on ambulatory care than the all-population mean.”
These numbers “suggest that Black individuals may lack access to the ambulatory care that can play a critical role in prevention,” the IHME team wrote.
“The US is consistently the wealthiest country in the world with subpar levels of coverage for a core set of health services; these findings provide additional evidence of the need to reduce disparities,” they concluded.
A second study led by Dr. Harlan Krumholz and colleagues at Yale University found little has changed in 20 years. They examined surveys of nearly 600,000 people taken from 1999 to 2018. “Despite a wide variety of health care and social policies and markedly increased health care spending, health inequities persisted with modest evidence of progress,” they wrote.
“Research has shown that Black, Latino/Hispanic, and American Indian individuals have worse self-rated health. The current study found that between 1999 and 2018, there had been no significant decrease in the percentage of people reporting poor or fair health across any racial and ethnic subgroup, and Black individuals consistently had the highest rates,” they added.
“Structural factors in US society, including systemic racism and barriers associated with citizenship status, can contribute to such inequities.”
Dr. George Mensah, senior adviser with the National Heart, Lung, and Blood Institute at the National Institutes of Health, who is unaffiliated with the research, said physicians can play a role in expanding access.
“One of the lessons we’ve learned is we need to stop thinking of always finding ways to tell patients, ‘go to the doctor,’ tell patients ‘go to the clinic,’” Mensah told reporters.
“Let’s find strategies that take the care to the community, to the patients.”
Alexander Ortega, a public health researcher at Drexel University, and Dylan Roby, a health policy analyst with the University of Maryland School of Public Health, say the studies show racism still exists in health care.
“Health equity can only be achieved through attention to the needs and perceptions of the communities served and to the elimination of racism and biases deeply imbedded in the system,” they wrote in an accompanying editorial.