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As the size of the U.S. population age 65 and older continues to grow, racial disparities within this population persist despite near universal insurance coverage provided through Medicare. Reform of the government administered program in 2003 has the potential to influence racial disparities due to increased privatization. This study compares racial disparities in health service utilization between Medicare fee-for-service and managed care, the two drastically different ways Medicare administers health care. Data was analyzed from the National Health Interview Survey (NHIS), a nationally representative study of the U.S. civilian, noninstitutionalized, household population. Included in this study were African American and white respondents aged 65 and older who participated in the NHIS in any year from 2004 to 2008 (N=22,364). Small differences were found in regard to the number of medical office visits, with African Americans reporting fewer visits. However, these differences were significant in only 25% of the analyses conducted. Across both types of Medicare, significant differences between African Americans and whites regarding consultations with a medical specialist and having surgery were found in 75% of analyses. In all analyses, African Americans were less likely to have interacted with a specialist or have surgery. The greatest difference in racial disparity between fee-for-service and managed care for all three health service use indicators was observed among those who were chronically ill and poor, and the smallest difference was observed among those who were chronically ill and very poor. These racial disparities in health service use may be linked to earlier life disparities in access to health care, higher out-of-pocket costs in Medicare fee-for-service, and the for-profit structure of managed care plans.

Racial and ethnic minorities utilize less healthcare than their similarly situated white counterparts in the United States, resulting in speculation that these actions may stem in part from less desire for care. In order to adequately understand the role of care-seeking for racial and ethnic disparities in healthcare, we must fully and systematically consider the complex set of social factors that influence healthcare seeking and use.

Data for this study come from a 2005 national survey of community-dwelling Medicare beneficiaries (N = 2,138). We examine racial and ethnic variation in intentions to seek care, grounding our analyses in the behavioral model of healthcare utilization. Our analysis consists of a series of nested multivariate logistic regression models that follow the sequencing of the behavioral model while including additional social factors.

We find that Latino, Black, and Native American older adults express greater preferences for seeking healthcare compared to whites. Worrying about one’s health, having skepticism toward doctors in general, and living in a small city rather than a Metropolitan Area, but not health need, socioeconomic status, or healthcare system characteristics, explain some of the racial and ethnic variation in care-seeking preferences. Overall, we show that even after comprehensively accounting for factors known to influence disparities in utilization, elderly racial and ethnic minorities express greater desire to seek care than whites.

We suggest that future research examine social factors such as unmeasured wealth differences, cultural frameworks, and role identities in healthcare interactions in order to understand differences in care-seeking and, importantly, the relationship between care-seeking and disparities in utilization.

This study represents a systematic analysis of the ways individual, social, and structural context may account for racial and ethnic differences in seeking medical care. We build on healthcare seeking literature by including more comprehensive measures of social relationships, healthcare and system-level characteristics, and exploring a wide variety of health beliefs and expectations. Further, our study investigates care seeking among multiple understudied racial and ethnic groups. We find that racial and ethnic minorities are more likely to say they would seek healthcare than whites, suggesting that guidelines promoting the elicitation and understanding of patient preferences in the context of the clinical interaction is an important step toward reducing utilization disparities. These findings also underscore the notion that health policy should go further to address the broader social factors relating to care-seeking in the first place.

For nearly two decades, researchers across the disciplines of social science and medicine have grappled with how to conceptualize and measure race to better explain racial inequality. Improvements have been made, but most scholars continue to assume that a “correct” measure of race exists or that different estimates between measures are essentially quantitative errors. However, obtaining different estimates from different measures of race might instead suggest that there are substantively different explanations for the disparities. I explore this possibility by revisiting conventional findings about racial differences in reported health screenings using data from the 1988 National Survey of Family Growth, which includes both the respondent's self-identification and how she was classified by the survey interviewer. Regression results indicate that differences in interviewer-classified race are more closely related to disparities in health screenings than self-identification; these findings complement recent research on the role of racial discrimination and implicit prejudice in clinical encounters and highlight the importance of using multiple measures of race in health care research.

Social and economic disparities between racial/ethnic groups are a feature of the American context into which immigrants are incorporated and a key determinant of population health. We ask whether racial/ethnic disparities in diabetes vary by nativity and whether native-immigrant disparities in diabetes vary by race and over time in the United States. Using the 2000–2015 National Health Interview Survey, we estimate logistic regressions to examine the interaction of race/ethnicity, nativity, and duration in the US in shaping diabetes patterns. Relative to their native-born co-ethnics, foreign-born Asian adults experience a significant diabetes disadvantage, while foreign-born Hispanic, Black, and White adults experience a significant advantage. Adjusting for obesity, education, and other covariates eliminates the foreign-born advantage for Black and White adults, but it persists for Hispanic adults. The same adjustment accentuates the disadvantage for foreign-born Asian adults. For Black and Hispanic adults, the protective foreign-born effect erodes as duration in the US increases. For foreign-born Asian adults, the immigrant disadvantage appears to grow with duration in the US. Relative to native-born White adults, all non-white groups regardless of nativity see a diabetes disadvantage because the racial/ethnic disadvantage either countervails a foreign-born advantage or amplifies a foreign-born disadvantage. Racial/ethnic differentials in diabetes are considerable and are influenced by each group’s nativity composition. Obesity and (for the foreign-born) time in the US influence these disparities, but do not explain them. These findings underscore the importance of unmeasured, systemic determinants of health in America’s race-conscious society.

This chapter explores the rise in genetic approaches to health disparities at the turn of the twenty-first century.

Analysis of public health policies, genome project records, ethnography of project leaders and leading genetic epidemiologists, and news coverage of international projects demonstrates how the study of health disparities and genetic causes of health simultaneously took hold just as the new field of genomics and matters of racial inequality became a global priority for biomedical science and public health.

As the U.S. federal government created policies to implement racial inclusion standards, international genome projects seized the study race, and diseases that exhibit disparities by race. Genomic leaders made health disparities research a central feature of their science. However, recent attempts to move toward analysis of gene-environment interactions in health and disease have proven insufficient in addressing sociological contributors to health disparities. In place of in-depth analyses of environmental causes, pharmacogenomics drugs, diagnostics, and inclusion in sequencing projects have become the frontline solutions to health disparities.

The chapter argues that genetic forms of medicalization and racialization have taken hold over science and public health around the world, thereby engendering a divestment from sociological approaches that do not align with the expansion of genomic science. The chapter thus contributes to critical discussions in the social and health sciences about the fundamental processes of medicalization, racialization, and geneticization in contemporary society.

Despite continuing socioeconomic and racial/ethnic gaps in many health care services, the National Healthcare Disparities Report (2004) documents parity in substance abuse treatment provision among individuals of varying socioeconomic and racial/ethnic backgrounds. This study investigates that achievement by analyzing the relationship between community socioeconomic and racial/ethnic disadvantage and organizational provision of substance abuse treatment, treatment need and utilization across United States counties, 2000, 2002 and 2003. Results confirm equity in service provision in poorer communities and those with higher concentrations of African Americans. Significant disparities remain, however, in communities with higher concentrations of Hispanics, youth and female-headed households. Limitations and implications for future studies of health care provision are discussed.

Blacks are more likely than white, in the United States, to experience a stillbirth. In this study, I use a structural perspective of race to create a heuristic model that combines medical and social epidemiological explanations to understand the racial disparity in stillbirths. Using data from the National Maternal and Infant Health Survey 1988 (NMIHS), I examine whether racial disparities in stillbirths can be explained by medical and social epidemiological variables. My findings show that medical and social epidemiological explanations do little to reduce the racial disparity. However, many medical model variables were important predictors of stillbirths including multiple gestations, being overweight, obesity, vaginal bleeding, advanced maternal age, and parity.

This chapter provides an introduction to the volume and reviews some issues related to provision of health care services to racial and ethnic minorities and other underserved population. In addition to this review of some of the material on underserved populations and what has often been called in the US “health care disparities” concerns, this chapter also serves as an introduction to the volume. As such, the chapter explains the organization of the volume and briefly comments on each of the chapters included in the volume.

In this chapter, we have proposed that an important approach to understanding occupational stress and well-being among racial and ethnic minority workers is to integrate the occupational health disparities paradigm into work stress research. As such, the current chapter provides a state-of-the-art review of the existing literature on occupational health disparities for Latinos, Asian Americans, and African Americans. Each of the three sections has highlighted the unique occupational health problems encountered by the specific racial and ethnic group as well as the research and policy gaps. We end with a series of recommendations for future research.

Scholars and activists working both within and outside the massive health-related machinery of government and the private sector and within and outside communities of color address the same fundamental questions: Why do health disparities exist? Why have they persisted over such a long time? What can be done to significantly reduce or eliminate them?