2015 National Healthcare Quality and Disparities Report and 5th Anniversary Update on the National Quality Strategy

Access and Disparities in Access to Health Care

To obtain high-quality care, Americans must first gain entry into the health care system. Measures of access to care tracked in the QDR include having health insurance, having a usual source of care, encountering difficulties when seeking care, and receiving care as soon as wanted. Historically, Americans have experienced variable access to care based on race, ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, gender identity, and residential location.

The Affordable Care Act was the most far-reaching effort to improve access to care since the enactment of Medicare and Medicaid in 1965. Provisions to increase health insurance options for young adults, early retirees, and Americans with pre-existing conditions were implemented in 2010. Open enrollment in Health Insurance Marketplaces began in October 2013 and coverage began in January 2014. Expanded access to Medicaid in many states began in January 2014, although a few had opted to expand Medicaid earlier.

After years without improvement, Access to Care has improved in a number of important areas since 2010.

People under age 65 who were uninsured at the time of interview, by age, 2010-2015 Q2

Line graph shows people under age 65 who were uninsured at the time of interview, by age. Text description is below the image.

Quarter (Q) Total 0-17 18-29 30-64
2010 Q1 17.5 7.4 30.6 18.2
Q2 19.2 9.1 31.9 20
Q3 18.8 8.2 32 19.7
Q4 17.2 6.5 29.1 18.6
2011 Q1 17.4 6.9 27.9 19.2
Q2 17.4 7.7 27.6 18.9
Q3 17.3 7.1 28.1 18.8
Q4 16.9 6.5 27.2 18.7
2012 Q1 17.6 6.7 28.2 19.4
Q2 16 6.4 25.1 17.7
Q3 17 6.8 27.4 18.6
Q4 17.2 6.4 26.9 19.2
2013 Q1 17.1 7.1 26.5 18.9
Q2 16.4 7.1 25.1 18.1
Q3 16.5 5.9 25.9 18.7
Q4 16.2 6 26.8 17.8
2014 Q1 15.2 6.6 22.2 17.1
Q2 12.9 5.6 19.8 14.1
Q3 13.2 5.3 21.5 14.3
Q4 12.1 4.2 19.1 13.7
2015 Q1 10.7 4.6 17.2 11.5
Q2 10.3 4.5 15.2 11.4

Key: Q = quarter.
Source: Cohen RA, Martinez ME. Health insurance coverage: early release of quarterly estimates from the National Health Interview Survey, January-June 2015. Hyattsville, MD: National Center for Health Statistics; November 2015. http://www.cdc.gov/nchs/data/nhis/earlyrelease/Quarterly_estimates_2010_2015_Q12.pdf (406.77 KB).

  • From 2010 to the second quarter of 2015, the percentage of people under age 65 who were uninsured at the time of interview decreased from 17.5% to 10.3%.
  • The percentage of people who were uninsured at the time of interview decreased for all age groups under age 65. Adults ages 18-29 experienced the largest declines in uninsurance.

In addition, while still present, some Access Disparities have been getting smaller since 2010. For example, disparities in health insurance have narrowed.

People ages 18-64 who were uninsured at the time of interview, by poverty status (top) and race/ethnicity (bottom), 2010-2015 Q2

Line graphs shows people ages 18-64 who were uninsured at the time of interview, by poverty status (top) and race/ethnicity (bottom). Text description is below the image.

Upper Chart:

Quarter (Q) Not Poor
(>200% FPL)
Poor
(<100% FPL)
Near Poor
(100-200% FPL)
2010 Q1 11.5 44 43.8
Q2 13.2 43.5 44.2
Q3 13.2 43.7 43.9
Q4 12.4 38.1 40.2
2011 Q1 12 39.8 40.3
Q2 12.5 37.2 42.1
Q3 12 42.2 39
Q4 11.6 41.1 39.2
2012 Q1 11.5 42.7 41
Q2 11.3 38.9 37.8
Q3 11.3 41 38
Q4 11.7 37.6 40
2013 Q1 11.7 39.1 39.2
Q2 11.4 38.9 38.4
Q3 12 40.2 37.9
Q4 10.5 39.2 38.6
2014 Q1 10.1 34.9 34.4
Q2 8.6 33.5 28.5
Q3 8.5 32 31.3
Q4 8.3 29.1 29.2
2015 Q1 7.5 28 23.8
Q2 7.5 25 24

Lower Chart:

Quarter (Q) White Black Hispanic
2010 Q1 15.6 27.9 42.4
Q2 17 26.5 44.9
Q3 16.7 28.6 44.1
Q4 16.1 25.6 41.5
2011 Q1 16.1 23.9 42
Q2 15.8 24.2 41.4
Q3 15.7 25 42.6
Q4 14.8 26.2 42.7
2012 Q1 16 26 42.6
Q2 14.2 21.9 39.7
Q3 15.1 24.1 40.5
Q4 15.1 22.6 42.2
2013 Q1 15.2 25.5 41.4
Q2 13.9 23.6 41.3
Q3 14.7 25.9 39.5
Q4 14 24.6 40.3
2014 Q1 13.5 20.2 35.7
Q2 11.1 15.9 33.2
Q3 11.4 17.5 34
Q4 10.5 17.2 31.8
2015 Q1 8.7 15.6 28.3
Q2 8.8 13.5 26.1

Key: Q = quarter. FPL = federal poverty level.
Source: Cohen RA, Martinez ME. Health insurance coverage: early release of quarterly estimates from the National Health Interview Survey, January-June 2015. Hyattsville, MD: National Center for Health Statistics; November 2015. http://www.cdc.gov/nchs/data/nhis/earlyrelease/Quarterly_estimates_2010_2015_Q12.pdf (406.77 KB)

  • From 2010 to the second quarter of 2015, among adults ages 18-64 years, the percentages who were uninsured at the time of interview decreased for all poverty status and racial/ethnic groups.
  • People in poor and near-poor households were more likely to be uninsured than people in households that were not poor. Poor-not poor and near poor-not poor gaps in uninsurance decreased over the 2010-2015 period.
  • Blacks and Hispanics were more likely to be uninsured than Whites. Black-White and Hispanic-White gaps in uninsurance decreased over the 2010-2015 period.

Disparities in having a usual place to go for medical care, a measure of realized access, have also narrowed.

Age-sex adjusted percentage of people of all ages with a usual place to go for medical care, by race/ethnicity, 2010-2015 Q1-2

Line graph shows age-sex adjusted percentage of people of all ages with a usual place to go for medical care, by race/ethnicity. Text description is below the image.

Race/Ethnicity 2010 2011 2012 2013 2014 2015 Q1-2
Total (Only Age Adjusted) 85.1 86.5 85.5 86.1 87.6 87.6
White 87.7 89.1 88.1 88.3 89.6 89.3
Black 83.7 85 84.9 85.4 87 87.1
Hispanic 76.6 78 77.1 78.9 81.6 83

Source: Ward BW, Schiller JS, Freeman G, and Clarke TC. Early release of selected estimates based on data from the January-June 2015 National Health Interview Survey. Hyattsville, MD: National Center for Health Statistics; November 2015. http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201511.pdf (1.146 MB). Estimates prior to 2015 may be found in earlier Early Release reports.
Note: Data only available for 2015 quarters 1 and 2.

  • From 2010 to the first half of 2015, the percentage of people with a usual place to go for medical care increased overall, for Blacks and for Hispanics. The increase was not statistically significant for Whites.
  • Gaps related to race/ethnicity were narrowing over time.

Despite improvements, Access Disparities persisted through 2013, especially among people in poor households, Hispanics, and Blacks.

Number and percentage of access measures for which members of selected groups experienced better, same, or worse access to care compared with reference group

Bar graph shows umber and percentage of access measures for which members of selected groups experienced better, same, or worse access to care compared with reference group. Text description is below the image.

Quality Poor vs. High Income (n=21) Hispanic vs. White (n=20) Black vs. White (n=22) Asian vs. White (n=20)  AI/AN vs. White (n=15)
Better 0 3 0 5 0
Same 0 3 10 8 11
Worse 21 14 12 6 4

Key: AI/AN = American Indian or Alaska Native; n = number of measures.
Note: Numbers of measures differ across groups because of sample size limitations. The relative difference between a selected group and its reference group is used to assess disparities. For income, the reference group is High Income. For race and ethnicity, the reference group is White.

  • Better = Population had better access to care than reference group. Differences are statistically significant, are equal to or larger than 10%, and favor the selected group.
  • Same = Population and reference group had about the same access to care. Differences are not statistically significant or are smaller than 10%.
  • Worse = Population had worse access to care than reference group. Differences are statistically significant, are equal to or larger than 10%, and favor the reference group.

Example: Compared with Whites, Hispanics had worse access to care on 14 of the 20 access measures, similar access on 3 measures, and better access on 3 measures.

  • People in poor householdsi had worse access to care than people in high-income households on all access measures (green).
  • Hispanics had worse access to care than Whites for two-thirds of access measures.
  • Blacks had worse access to care than Whites for about half of access measures.
  • Asians and American Indians and Alaska Natives had worse access to care than Whites for about one-third of access measures.

i. Throughout this report, poor indicates family income less than the federal poverty level, and high income indicates family income four times the federal poverty level or greater. In 2013, the federal poverty level for a family of four living in the continental United States was $23,550.


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Page last reviewed May 2016
Page originally created May 2016
Internet Citation: Access and Disparities in Access to Health Care. Content last reviewed May 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqdr15/access.html