Minority Health and Health Equity Archive

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Author: search.filters.author.LaVeist, Thomas A.Subject: search.filters.subject.Access To Healthcare

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    THE ECONOMIC BURDEN OF HEALTH INEQUALITIES IN THE UNITED STATES
    (2009) LaVeist, Thomas A.; Gaskin, Darrell J.; Richard, Patrick
    We estimated the economic burden of health disparities in the United States using three measures: (1) direct medical costs of health inequalities, (2) indirect costs of health inequalities, and (3) costs of premature death. Our analysis found: • Between 2003 and 2006 thecombined costs of health inequalitiesand premature death in the United States were $1.24 trillion. • Eliminating health disparities for minorities would havereduced direct medicalcareexpenditures by $229.4 billion for the years 2003-2006. • Between 2003 and 2006, 30.6% of direct medicalcareexpenditures for African Americans, Asians,and Hispanics were excess costs due to health inequalities. • Eliminating health inequalities for minorities would havereduced indirectcostsassociated with illnessand premature death by morethan onetrillion dollars between 2003 and 2006.
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    Mistrust of Health Care Organizations Is Associated with Underutilization of Health Services
    (2009) LaVeist, Thomas A.; Isaac, Lydia A.; Williams, Karen Patricia
    PURPOSE: We report the validation of an instrument to measure mistrust of health care organizations and examine the relationship between mistrust and health care service underutilization. METHODS: We conducted a telephone survey of a random sample of households in Baltimore City, MD. We surveyed 401 persons and followed up with 327 persons (81.5 percent) 3 weeks after the baseline interview. We conducted tests of the validity and reliability of the Medical Mistrust Index (MMI) and then conducted multivariate modeling to examine the relationship between mistrust and five measures of underutilization of health services. RESULTS: Using principle components analysis, we reduced the 17-item MMI to 7 items with a single dimension. Test-retest reliability was moderately strong, ranging from Pearson correlation of 0.346-0.697. In multivariate modeling, the MMI was predictive of four of five measures of underutilization of health services: failure to take medical advice (b=1.56, p<.01), failure to keep a follow-up appointment (b=1.11, p=.01), postponing receiving needed care (b=0.939, p=.01), and failure to fill a prescription (b=1.48, p=.002). MMI was not significantly associated with failure to get needed medical care (b=0.815, p=.06). CONCLUSIONS: The MMI is a robust predictor of underutilization of health services. Greater attention should be devoted to building greater trust among patients.
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    Perceived Discrimination and Adherence to Medical Care in a Racially Integrated Community
    (2007) Casagrande, Sarah Stark; Gary, Tiffany L.; LaVeist, Thomas A.; Gaskin, Darrell J.; Cooper, Lisa A.
    Background Past research indicates that access to health care and utilization of services varies by sociodemographic characteristics, but little is known about racial differences in health care utilization within racially integrated communities. Objective To determine whether perceived discrimination was associated with delays in seeking medical care and adherence to medical care recommendations among African Americans and whites living in a socioeconomically homogenous and racially integrated community. Design A cross-sectional analysis from the Exploring Health Disparities in Integrated Communities Study. Participants Study participants include 1,408 African-American (59.3%) and white (40.7%) adults (≥18 years) in Baltimore, Md. Measurements An interviewer-administered questionnaire was used to assess the associations of perceived discrimination with help-seeking behavior for and adherence to medical care. Results For both African Americans and whites, a report of 1–2 and >2 discrimination experiences in one’s lifetime were associated with more medical care delays and nonadherence compared to those with no experiences after adjustment for need, enabling, and predisposing factors (odds ratio [OR]=1.8, 2.6; OR=2.2, 3.3, respectively; all P<.05). Results were similar for perceived discrimination occurring in the past year. Conclusions Experiences with discrimination were associated with delays in seeking medical care and poor adherence to medical care recommendations INDEPENDENT OF NEED, ENABLING, AND PREDISPOSING FACTORS, INCLUDING MEDICAL MISTRUST; however, a prospective study is needed. Further research in this area should include exploration of other potential mechanisms for the association between perceived discrimination and health service utilization.