2016 National Healthcare Quality and Disparities Report

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.

Figure 9. Number and percentage of access measures for which measure trends were better, same, or worsening, 2014

Bar graph showing number and percentage of access measures for which measure trends were better, same, or worsening: Improving - 7; No Change - 10; Worsening - 3. Access Total (n=20).

Key: n = number of measures.
Note: The measures represented in this chart are available in Appendix B.

Most access measures (70%) tracked in this report did not experience significant improvement (2000-2014) (Figure 9; Appendix A, Graph 1 shows examples). Some of these measures are:

  • Adults who needed care right away for an illness, injury, or condition in the last 12 months who sometimes or never got care as soon as needed.
  • People who were unable to get or delayed in getting needed prescription medicines in the last 12 months.
  • People with a usual primary care provider.

There were significant gains in having health insurance. Several subgroups did better than reference groups in 2014 on health insurance coverage measures for people under 65. Most of the recent increases in insurance coverage for people under 65 were due to Medicaid and Marketplace coverage (Selden, et al., 2016; Vistnes & Miller, 2016).

Most disparities showed no statistically significant changes, with a few exceptions, including the following measures that improve over time. The disparity between the comparison groups and reference groups are shrinking for the following measures:

  • People under age 65 with any private health insurance:
    • Adults with limitations in basic activities vs. neither basic nor complex activities.
  • Adults age 65 and over with any private health insurance:
    • Hispanics vs. non-Hispanic Whites.
    • American Indians/Alaska Natives (AI/ANs) vs. Whites.
    • Blacks vs. Whites.
  • People with a usual source of care, excluding hospital emergency rooms, who has office hours at night or on weekends:
    • AI/ANs vs. Whites.
  • Adults who had a doctor’s office or clinic visit in the last 12 months and needed care, tests, or treatment who sometimes or never found it easy to get the care, tests, or treatment:
    • Asians vs. Whites.

Figure 10. Number and percentage of access measures for which members of selected groups experienced better, same, or worse access to care compared with reference group, 2014

Bar graph showing number 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.

  Poor vs. High Income
(n=20)
Black vs. White
(n=20)
Asian vs. White
(n=18)
NHOPI vs. White
(n=5) 
AI/AN vs. White
(n=11) 
Hispanic vs. Non-Hispanic White
(n=20)
Better 0 0 8   0 2
Same 1 10 5 4 7 3
Worse 19 10 5 1 4 15

Key: n = number of measures; NHOPI = Native Hawaiian or Other Pacific Islander; AI/AN = American Indian or Alaska Native.
Note: The measures represented in this chart are available in Appendix B. The number of measures is based on the measures that have data for each population group.

  • Poor people (at or below 100% of the Federal Poverty Level [FPL]) experienced worse access to care compared with high-income people for all access measures except one measure (Figure 10): People with a usual source of care, excluding hospital emergency rooms, with office hours at night or on weekends (AHRQ, Medical Expenditure Panel Survey [MEPS]).
    • Blacks experienced worse access to care compared with Whites for 50% of measures.
    • Asians experienced worse access to care compared with Whites for 28% of measures and better access for 44% of measures.
    • Among the 11 measures that had data for AI/ANs, 64% showed no statistically significant differences between AI/ANs and Whites.
    • Hispanics experienced worse access to care compared with Whites for 75% of measures.

Figure 11. Improving: People ages 0-64 who were uninsured at the time of interview, by age, 2010-2016, by quarter

Line graph showing people ages 0-64 who were uninsured at the time of interview, by age. Text description is below the image.

Year/Quarter (Q) Total Ages 0-17 Ages 18-29 Ages 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
Q3 10.8 4.5 16.9 11.9
Q4 10.3 4.3 16.5 11.2
2016 Q1 10 5 15.1 10.8
Q2 10.8 5 16.3 11.7
Q3 10.1 4.8 13.9 11.5
Q4 10.8 5.6 15.4 11.7

Key: Q = quarter.
Source: National Center for Health Statistics, National Health Interview Survey Early Release Program, January 2010-December 2016.
Note: For this measure, lower rates are better.

  • From the first quarter of 2010 to the fourth quarter of 2016, the percentage of people ages 18-29 years who were uninsured at the time of interview decreased from 30.6% to 15.4% (Figure 11).
  • During this time, the percentage of people who were uninsured at the time of interview also decreased for all other age groups under 65.

Figure 12. Improving: Adults ages 18-64 who were uninsured at the time of interview, by poverty status, 2010-2016, by quarter

Line graph showing adults ages 18-64 who were uninsured at the time of interview, by poverty status. Text description is below the image.

Year/Quarter Poor Near Poor Not Poor
2010 Q1 44.0 43.8 11.5
Q2 43.5 44.2 13.2
Q3 43.7 43.9 13.2
Q4 38.1 40.2 12.4
2011 Q1 39.8 40.3 12
Q2 37.2 42.1 12.5
Q3 42.2 39 12
Q4 41.1 39.2 11.6
2012 Q1 42.7 41 11.5
Q2 38.9 37.8 11.3
Q3 41.0 38 11.3
Q4 37.6 40 11.7
2013 Q1 39.1 39.2 11.7
Q2 38.9 38.4 11.4
Q3 40.2 37.9 12
Q4 39.2 38.6 10.5
2014 Q1 34.9 34.4 10.1
Q2 33.5 28.5 8.6
Q3 32.0 31.3 8.5
Q4 29.1 29.2 8.3
2015 Q1 28.0 23.8 7.5
Q2 25.0 24 7.5
Q3 25.2 24.4 8.1
Q4 22.4 24.2 7.3
2016 Q1 24.7 23.6 6.5
Q2 27.2 23.4 7.5
Q3 26.2 22 7.1
Q4 26.7 23.8 7.8

Key: Q = quarter.
Source: National Center for Health Statistics, National Health Interview Survey Early Release Program, January 2010-December 2016.
Note: For this measure, lower rates are better. Poverty categories are based on the Federal Poverty Level (FPL). Poor = below the FPL; near poor = 100% to <200% of the FPL; not poor = 200% or more of the FPL.

  • From the first quarter of 2010 to the fourth quarter of 2016, the percentage of people ages 18-64 who were uninsured at the time of interview decreased for all poverty status groups (Figure 12). The percentage of uninsured near-poor adults dropped from 43.8% to 23.8% during this time.
  • In quarter 4 of 2016, 26.7% of poor adults were uninsured at the time of interview compared with 7.8% of adults who were not poor.

Figure 13. Improving: Adults ages 18-64 who were uninsured at the time of interview, by race/ethnicity, 2010-2016

Line graph showing adults ages 18-64 who were uninsured at the time of interview, by race/ethnicity. Text description is below the image.

Year/Quarter 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
Q3 8.9 14.7 29.3
Q4 8.3 14 27.2
2016 Q1 8.4 13 24.5
Q2 9 16.7 25.1
Q3 7.9 15.7 24.5
Q4 8.9 14.6 25.9

Key: Q = quarter.
Source: National Center for Health Statistics, National Health Interview Survey Early Release Program, January 2010-December 2016.
Note: For this measure, lower rates are better. White and Black are non-Hispanic. Hispanic includes all races. Data for Asian and Pacific Islanders and American Indians/Alaska Natives are not available for this measure.

  • From the first quarter of 2010 to the fourth quarter of 2016, the percentage of people ages 18-64 who were uninsured at the time of interview declined for Whites (15.6% to 8.9%), Blacks (27.9% to 14.6%), and Hispanics (42.4% to 25.9%) (Figure 13).
  • In addition, the disparities between Blacks and Whites and Hispanics and Whites were getting smaller over time.

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Page last reviewed July 2017
Page originally created July 2017
Internet Citation: Access and Disparities in Access to Health Care. Content last reviewed July 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqdr16/access.html