Differences in access to outpatient medical care for black and white adults in the rural south

Objectives: We compared black and white adults in the rural South on multiple indicators of access to outpatient medical care and assessed whether any differences might be explained by group differences in socioeconomic situations or proximity to medical resources. Design: Cross-sectional telephone survey. Subjects: Survey respondents were 1237 black and 2158 white adults from 113 rural counties in 6 southern states. Measures: Blacks and whites were compared on a variety of commonly used survey measures of access, some followed in the Healthy People 2010 Initiative. Access comparisons were adjusted for age, gender, and health status and then reassessed with adjustments for individual socioeconomic indicators and county medical resources: physician-to-population ratios, the presence of hospitals and federally qualified health centers, and urban adjacency. Results: Compared with whites, blacks reported similar or higher use of outpatient services over the previous year, including the likelihood of having had an outpatient physician visit and regular checkup. Nevertheless, blacks more often reported forgoing needed care, encountering various barriers, and experiencing dissatisfaction with some aspects of care. Adjusting for socioeconomic actors generally reduced but did not eliminate black-white access differences, whereas adjusting for county medical care resources did not affect measured group differences. Conclusions: Blacks and whites in the rural South report similar use rates of outpatient medical care, but blacks more often report unmet needs, barriers to care, and dissatisfaction with care. Beyond socioeconomic differences, black versus white differences in sites of care, the quality of care received, the quality of interactions with providers, and expectations for their care may explain group reported access differences.