Survey: Black Californians hit hardest by health inequities

More than half of black Californians said there was a time in recent years when they thought they would have received better health care if they were of a different racial or ethnic group, according to a report released Thursday.

In comparison, 27% of Latinos, 12% of Asians, and 4% of Whites responded the same way, the report said.

The report from the California Health Care Foundation, a nonprofit organization that focuses on health issues in the state, summarizes the results of a survey that asked more than 1,700 Californians about their views on health equity, health care costs, access to health care, housing, and their experiences in the US were surveyed healthcare system and more. The findings come as lawmakers, healthcare providers and public health agencies grapple with how to explain and curb longstanding racial inequalities.

Kristof Stremikis, director of market analysis and insights at the California Health Care Foundation, said he was “not at all surprised” by the report’s findings.

“We’ve known for years that there is unequal treatment within the system, and there are certainly unequal outcomes within the system, which should be absolutely nothing new to anyone at this point,” Stremikis said. “There have been years of data points and studies on this very subject…it’s deeply disappointing.”

The survey also found racial differences in the way people interacted with healthcare providers.

Overall, according to the report, 54% of Californians had experienced at least one negative vendor interaction, including 64% of low-income Californians and 50% of higher-income Californians.

But even after accounting for geographic region, income, gender, language, and age, black Californians were twice as likely as white Californians to report negative experiences with healthcare providers in recent years.

Californians were asked about their overall experiences of the healthcare system, including whether they ever felt a doctor or other provider didn’t listen to them, didn’t talk to them, didn’t treat them with respect, or didn’t believe they were telling the truth .

They were also asked if a provider had refused to order a test or treatment they felt they needed, claimed they were personally at fault for a health issue they were having, wrongly prioritized others, or failed to respect their privacy .

The survey found that 69% of Black respondents and 62% of Latinos reported these experiences, while 48% of Whites and 48% of Asians reported the same.

Black Californians most commonly experienced a healthcare provider not listening to them, assuming something about them without asking, or not believing they were telling the truth. Meanwhile, Latinos faced similar issues as blacks, but of all races, a provider was more likely to blame them for their health problems.

“After using statistical methods to keep all of these things constant, race is still an extremely important predictor of a person’s experience with a healthcare provider, and unfortunately there is inequality there,” Stremikis said.

Confidence in primary care also varied by race. According to the survey, black Californians were almost twice as likely as white Californians to say they didn’t trust their family doctor’s judgment.

While the majority of Californians surveyed said they were concerned about medical debt and health care affordability, the foundation’s survey found that the level of concern also varied by race.

More than half of Latinos and 48% of Blacks surveyed said they had medical debt, compared to 28% of Whites and 27% of Asians. The poll also found that 40% of Latinos had trouble paying medical bills, compared to 36% of Blacks, 20% of Whites, and 17% of Asians.

The survey found that blacks and Latinos are more likely to forgo medical and dental care because of the cost.

Last year, 55% of blacks and 49% of Latinos skipped dental work or checkups because of cost. Compared to other races, Black Californians were more likely to skip dental care, postpone medical treatments or cut pills in half, and skip doses of medication to save money. Concerns about cost meant Latinos were more likely to skip recommended medical tests or not fill out a prescription. The survey found that 31% of Black and Hispanic Californians put off mental health treatment because of cost, while Asians are the least likely to miss treatment for this reason.

Two-thirds of Blacks and 53% of Latinos said delaying treatment because of cost made their condition worse, compared with 47% of Whites and 35% of Asians.

dr David Carlisle, president of Charles R. Drew University of Medicine and Science in Willowbrook, said the poll results were not surprising. But he said after the 2020 death of George Floyd in Minneapolis, more people in communities and the health care system “have tuned into issues of discrimination, prejudice and inequality.”

He said California has made strides by expanding access to Medi-Cal, the state’s Medicaid program, and by enrolling people in various health insurance plans. But people are still struggling to access care and needed medicines because their coverage doesn’t go far enough to cover costs, he said.

Carlisle said people seeking treatment often think they have insurance “only to find they don’t have as good insurance as they thought” when a bill arrives. He said it’s common for patients worried about the cost of a co-payment to miss getting their medication.

“It’s like people take a quilt and they pull it out of every corner and stretch it out,” Carlisle said. “As a result, more and more people are falling through the cracks.”