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The study looks at visits and spending from the civil rights era to the passage of the Affordable Care Act.

With racial disparities in health care seeking rates and rising costs, policy changes are needed to address entrenched racial disparities in the US healthcare system. new research said.

After 1963, the gap between white and black outpatient visits narrowed and then widened. Health care spending followed a similar pattern, and white patients’ total health care use, measured in dollars per capita, exceeded that of black patients each year from 1963 to 2019, the study said.

“Trends in U.S. Black and White Health Care Utilization, 1963-2019” was published June 14 in the magazine. JAMA open network. Data were analyzed on 154,859 black patients and 446,944 white patients, children, adults, and the elderly, from surveys conducted in 1963, 1970, 1977, 1980, 1987, and continuously from 1996 to 2019. The researchers counted visits to outpatients, dentists, emergency departments, and hospitals measured in bed-days.

While the results do not prove a causal relationship, changes in disparities in healthcare utilization after 1963 coincided with the introduction of the Medicare and Medicaid programs, which outlawed segregation in healthcare facilities, according to a study led by corresponding author Samuel L. Dickman. MD, to the Texas Policy Assessment Project at the University of Texas at Austin. The era saw the emergence of new community health centers and civil rights systems “that improved blacks’ access to housing, jobs, education, and the ballot box,” the study said.

Health care utilization data began to diverge in the 1980s, coinciding with a weakening of civil rights protections, an increase in incarceration rates, especially for black men, and a stagnation in Medicaid enrollment. In 2014, the Affordable Care Act (ACA) narrowed racial disparities in self-reported coverage and access to health care, but gaps remain, the study says.

“The current gap between whites and blacks in ambulatory care visits is larger than ever before, and the cost gap is larger than in the pre-ACA period and is at an all-time high measured in real (inflation-adjusted) dollars.” , the study said.

Insurance coverage may have been a factor, but differences remained when analyzing privately insured patients, Medicaid participants, or older adults. Other barriers could be insurance co-payments and deductions, lower incomes, lack of transportation, inability to take vacations, lack of trust in the health care system, and a shortage of black medical practitioners, the study says.

“The persistence of large racial disparities in the amount of care provided to white and black patients in the US suggests that structural racism is ingrained in the healthcare system,” the study said. Solutions may include addressing the shortage of black health care workers and managers, investing in health care facilities that serve black people, expanding population coverage, and restoring black patient confidence in the health care system.

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