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DIVERSE COMMUNITIES, COMMON CONCERNS:ASSESSING HEALTH CARE QUALITY
FOR MINORITY AMERICANS
FINDINGS FROM THE COMMONWEALTH FUND2001 HEALTH CARE QUALITY SURVEY
CHARTS
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Poverty Status, by Race/Ethnicity
13% 9%19%
30%
13%
23%21%
31%
30%
20%
0%
30%
60%
Total White AfricanAmerican
Hispanic AsianAmerican
100%–199% of Poverty
Less than 100% of Poverty
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Chart 1
36%30%
50%
60%
33%
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African Americans and Hispanics Most Likelyto Be Uninsured During the Past Year
16% 12%22%
35%
14%
8%8%
8%
11%
7%
0%
25%
50%
Total White AfricanAmerican
Hispanic AsianAmerican
Insured Now, Time Uninsured inPast Year
Uninsured When Surveyed
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults ages 18–64
24%20%
30%
46%
21%
Chart 2
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Self-Rated Health Status by Race/Ethnicity
16%14%
17%
22%
17%
0%
15%
30%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults rating health as fair or poor
Chart 3
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16%
22%
25%
16%
20%
0%
15%
30%
Total U.S. Total Hispanic Mexican Puerto Rican CentralAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Self-Rated Health Status by Hispanic Origin
Percent of adults rating health as fair or poor
Chart 4
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16% 17%
11%
40%
29%
0%
25%
50%
Total U.S. Total AsianAmerican
ChineseAmerican
VietnameseAmerican
KoreanAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults rating health as fair or poor
Self-Rated Health Status by Asian Origin Chart 5
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25% 24%
30%
40%
21%
0%
30%
60%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Self-Rated Health Status Among AdultsAge 50 and Older, by Race/Ethnicity
Percent of adults age 50 and older rating health as fair or poor
Chart 6
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Chronic Disease Among Adults Age 50and Older, by Race/Ethnicity
64% 64%
77%68%
42%
0%
40%
80%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults age 50 and older diagnosed with chronic disease*
Chart 7
* Diagnosed with at least one of following seven conditions: asthma, cancer, heart disease, diabetes, high blood pressure, obesity, or anxiety/depression.
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Patient–Physician Communication
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Hispanics and Asian Americans Had More Communication Difficulties During Doctor Visits
66% 68% 68%57%
49%
66% 69%61%
56%48%
0%
50%
100%
Total White AfricanAmerican
Hispanic AsianAmerican
Felt Doctor Listened to Everything They Said Understood Everything Doctor Said
Base: Adults with health care visit in past two years.
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Chart 8
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Minorities More Likely to Forgo Asking Questions of Their Doctor
12%10%
13%
19%
14%
0%
5%
10%
15%
20%
25%
Total White AfricanAmerican
Hispanic AsianAmerican
Base: Adults with health care visit in past two years.
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults reporting they had questions which they did not ask on last visit
Chart 9
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Minorities Face Greater Difficulty in Communicating with Physicians
19%16%
23%
33%
27%
0%
20%
40%
Total White AfricanAmerican
Hispanic AsianAmerican
Base: Adults with health care visit in past two years.* Problems include understanding doctor, feeling doctor listened, had questions but did not ask.
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults with one or more communication problems*
Chart 10
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Hispanics Who Speak Spanish as Primary Language Have More Problems
Communicating with Their Physicians
12% 11%17%
26%23% 25% 24%
43%
0%
25%
50%
Doctor listened tosome or only a
little
Patientunderstood some
or only a little
Had question,didn't ask
One or moreproblems with
communication
Hispanic—English at home Hispanic—Spanish at home
Base: Hispanics with health care visit in past two years.
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Chart 11
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Following Doctor’s Advice, by Race/Ethnicity
Total White
African American Hispani
c
Asian American
Time did not follow doctor’s advice (%)
24 25 22 22 22
Reasons Why: (%)
Disagreed 39 39 40 34 51
Costs 27 24 30 41 27
Too difficult 26 25 26 31 46
Against personal beliefs
20 19 13 26 32
Didn’t understand 7 5 13 16 14
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Chart 12
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Hispanics and Asian Americans Find ItLess Easy to Understand Instructions
on Prescription Bottles
79% 82% 79%
64% 66%
0%
50%
100%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults reporting it very easy to understand prescription bottle
Chart 13
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Minority Americans Find It Less Easy to Understand Instructions from Doctor’s Office
57% 59%55%
45% 44%
0%
35%
70%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults reporting it very easy to understandinformation from doctor’s office
Chart 14
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Non-English* Speakers Have More Difficulty Understanding Instructions from Doctor’s Office
57%51%
37%47%
16%
0%
35%
70%
Total U.S. HispanicEnglish
Speaking
HispanicSpanish
Speaking
AsianAmericanEnglish
Speaking
AsianAmerican
Non-Englishspeaking
* English is not primary language spoken at home.
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults reporting it very easy to understandinformation from doctor’s office
Chart 15
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Hispanics and Asian Americans HaveLess Confidence in Their Doctors
69% 72% 69%
57% 54%
0%
40%
80%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults reporting great deal of confidence in doctor
Chart 16
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Minorities Less Involved in Their Health Care Decisions Than They Would Like to Be
75% 78%73%
65%56%
0%
40%
80%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults involved in health care decision as much as they wanted
Chart 17
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Cultural Competence inHealth Care Services
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Minorities Believe They Would ReceiveBetter Health Care If They Were of a
DifferentRace and/or Ethnicity
5%
1%
15%
13%11%
0%
5%
10%
15%
20%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Chart 18
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Hispanics and African Americans More Likelyto Feel Treated with Disrespect
11%9%
16%18%
13%
0%
10%
20%
Total White AfricanAmerican
Hispanic AsianAmerican
* Felt disrespected because of ability to pay, to speak English, or of their race/ethnicity.
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults who felt they were treated with disrespect*
Chart 19
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Minorities More Likely to Feel that Staying Healthy Is a Matter of Luck
15%12%
24%26%
19%
0%
15%
30%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults who strongly agree that “staying healthy is a matter of luck”
Chart 20
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Use of Language Interpretation Services
Of those who need interpreter, percent who always or usually get interpreter
48%
With interpreter’s help, fully understood what doctor was saying
70%
Usual interpreter:
Staff person 53%
Family or friend 43%
Trained medical interpreter 1%
Person usually available 74%
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Chart 21
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Use of Alternative Care
32%34%
24%27%
29%
0%
20%
40%
Total White AfricanAmerican
Hispanic AsianAmerican
* Used herbal medicine, acupuncture, chiropractor, and/or traditional healer in past two years.
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent reporting use of alternative care*
Chart 22
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Percent Who Say Cultural/Religious BeliefsAre a Reason for Use of Alternative Care
8%4%
12%
22%27%
0%
20%
40%
Total White AfricanAmerican
Hispanic AsianAmerican
Percent who use alternative care* for cultural/religious reasons
Chart 23
Base: Those using any alternative care in past two years.* Used herbal medicine, acupuncture, chiropractor, and/or traditional healer.
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
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Minority Patients Less Likely to Inform Doctor of Use of Alternative Care
66%70%
55%50%
63%
0%
35%
70%
Total White AfricanAmerican
Hispanic AsianAmerican
Base: Those using any alternative care in past two years.* Used herbal medicine, acupuncture, chiropractor, and/or traditional healer.
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent who told doctor about use of alternative care*
Chart 24
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Quality of Clinical Care forMinority Populations
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Satisfaction with Quality of Health Care
62% 65%61%
56%
45%
0%
40%
80%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults “very satisfied” in past two years
Chart 25
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Physical Exam in Past Year, by Race/Ethnicity
48% 47%
57%
48%
41%
0%
30%
60%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults receiving exam
Chart 26
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Older Adults with Physical Exam in Past Year
56% 56%61%
51%45%
0%
35%
70%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults over 50 receiving exam
Chart 27
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Pap Test in Past Year, by Race/Ethnicity
53% 53%
60%54%
45%
0%
35%
70%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of women who received Pap test in past year
Chart 28
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Colon Cancer Screening in Past Year
27% 28%31%
18%16%
0%
20%
40%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults 50 and older receiving colon cancer screening in past year
Chart 29
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Prostate Cancer Screening in Past Year,by Race/Ethnicity
48% 50% 49%
40% 38%
0%
30%
60%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of men 40 and older receiving prostate cancer screening in past year
Chart 30
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Smoking Cessation Counseling
79% 82%78%
58%68% 67%
39%
0%
50%
100%
Total White AfricanAmerican
Hispanic AsianAmerican
Hispanic English-
Speaking
Hispanic Spanish-Speaking
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of current smokers counseled by physician to quit
Chart 31
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Eye Screening for Diabetic Patients
73% 73%
84%
66%70%
0%
50%
100%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of respondents with diabetes, eye exam in past year
Chart 32
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Access to Health Care
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Minorities Less Likely to Receive Careat a Doctor’s Office
76% 80%
66%59%
73%
0%
50%
100%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults reporting doctor’s office as regular source of care
Chart 33
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African Americans and Hispanics More Likelyto Have No Regular Source of Care
8%
6%
13%14%
8%
0%
10%
20%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults reporting emergency room or none as regular source of care
Chart 34
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One of Five Hispanics Names CommunityHealth Center as Regular Source of Care
8% 7%10%
20%
8%
0%
15%
30%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults reporting community health center as regular source of care
Chart 35
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18%15%
22%
28%
24%
0%
10%
20%
30%
Total White AfricanAmerican
Hispanic AsianAmerican
Minority Americans Report Less Choicein Where to Go for Medical Care
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults reporting “very little” or “no” choice
Chart 36
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Minority Americans Are Less Likely to Havea Regular Doctor
76%80%
70%
57%
68%
0%
40%
80%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults with a regular doctor
Chart 37
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Less Than Half of Respondents Have Hadthe Same Doctor for More Than Five Years
44% 46%43%
37%32%
0%
30%
60%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults with same doctor for more than five years
Chart 38
Base: Adults with a regular doctor.
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Whites and Asian Americans Most Likelyto Have Regular Physician of the Same Race
82%
23% 26%
39%
0%
50%
100%
White AfricanAmerican
Hispanic Asian American
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of respondents with physician of same race/ethnicity
Chart 39
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Minorities Without a Regular DoctorMore Likely to Use Emergency Room for Care
16%
27%24%
14%
4%7% 7%
4%
0%
15%
30%
White AfricanAmerican
Hispanic Asian American
No Regular Doctor Regular Doctor
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent reporting emergency room or no regular place of care
Chart 40
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Adults with No Regular Doctor Report More Communication Problems with Their Physicians
25%30%
47%
36%
14%20%
25% 23%
0%
20%
40%
60%
White AfricanAmerican
Hispanic Asian American
No Regular Doctor Regular Doctor
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults reporting one or more communication problems
Chart 41
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Adults with Regular Doctors More Satisfiedwith the Quality of Their Health Care
50% 48%40%
28%
68% 65% 65%
48%
0%
40%
80%
White AfricanAmerican
Hispanic Asian American
No Regular Doctor Regular Doctor
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults very satisfied with quality of health care in past two years
Chart 42
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Minorities Are Less Confident They Will Receive Good-Quality Health Care in the Future
49%52%
47%
40% 39%
0%
20%
40%
60%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults very confident they can get good-quality care in future
Chart 43
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African Americans and Hispanics ReportLess Use of Internet for Health Information
26%28%
19% 19%
28%
0%
20%
40%
Total White AfricanAmerican
Hispanic AsianAmerican
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent using Internet often to obtain health information
Chart 44
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Health Insurance Coverage
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Uninsured Are Less Confident They Will Receive
Good-Quality Health Care in the Future
35% 38%33% 32%
20%
51% 52% 50%46%
39%
0%
30%
60%
Total White AfricanAmerican
Hispanic AsianAmerican
Uninsured* Continuously Insured
* Adults uninsured at any time in past year.
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults 18–64 very confident they can get good-quality care in future
Chart 45
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Uninsured Report Lower Rates ofColon Cancer Screening
17%13%
9%
29%
38%
21%
0%
25%
50%
White African American Hispanic
Uninsured* Continuously Insured
* Adults uninsured at any time in past year.
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults ages 50–64 receiving colon cancer screening in past year
Chart 46
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Uninsured Minorities Report Little Choicein Source of Health Care
25%
38% 39%
32%
13% 14% 16%20%
0%
25%
50%
White AfricanAmerican
Hispanic Asian American
Uninsured* Continuously Insured
* Adults uninsured at any time in past year.
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults 18–64 reporting very little or no choice in source of care
Chart 47
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More Than One-Fifth of Uninsured Hispanics and African Americans Have No Regular Place of Care
23%
16%
24%22%
13%
6% 5%9%
7% 6%
0%
15%
30%
Total White AfricanAmerican
Hispanic AsianAmerican
Uninsured* Continuously Insured
* Adults uninsured at any time in past year.
Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Percent of adults 18–64 who used an emergency room as usual source of care,or had no regular place for health care in the past year
Chart 48