The purpose of this study was to examine barriers to care faced by Hispanics, African Americans, Asian Americans and non-Hispanic whites to assess whether the barriers vary across these groups and whether they differ between the privately-insured managed care and non-managed care enrollees within each group. Data were obtained from the household component of the 1996 MEPS, a nationally representative survey sponsored by the Agency for Healthcare Research and Quality.

Although most respondents reported being satisfied with their usual source of care (8% of the total sample), a substantial proportion of respondents reported having barriers to care, with the degree varying by racial group. For example, 24% of Hispanics and 16% of Asian Americans versus 10% of African Americans and non-Hispanic whites had difficulty obtaining care. Respondents were more likely to report insurers/providers as the reason for this difficulty than personal reasons.

Families with managed care were more likely to have difficulty obtaining care than non-managed care enrollees across race/ethnic groups, and their satisfaction was lower. However, more patients with managed care were likely to go to their usual source of care for preventive health care (particularly among Hispanics and Asian Americans) and reported positively on other continuity of care items.

For Hispanics, the largest proportion of people with barriers were those without insurance; for the other racial/ethnic groups, the proportions of those with barriers were similar between those without insurance and those with managed care (the smallest proportion of those with barriers was in non-managed care). However, across ethnic groups, the largest proportion of those without barriers was in managed care plans. Older age was generally associated with not having barriers to care, and poorer physical/mental health was associated with having barriers to care for African Americans and non-Hispanic whites. In multivariate analysis, factors that distinguished those with barriers to care from those without were ethnicity (Hispanic and Asian American), insurance status, and health ratings.

The authors conclude that these results suggest that measures of satisfaction and continuity of care are useful in identifying differences in access to care across racial/ethnic groups and that expanding the range of outcome measures (related to access to care) helps to identify different facets of quality that vary across types of care and patient populations. Further, increased access to insurance may reduce some of the barriers to care experienced by the uninsured, but there are additional barriers to care that are faced by insured persons as well. Finally, in this study, barriers to care and satisfaction with care varied by race/ethnic group, both among those with managed care and those with non-managed care.