Chartbook on Access to Health Care

Ensuring well-coordinated, high-quality health care requires the establishment of a supportive health system infrastructure (IOM, 2010). Key elements include:

• Well-distributed capable and qualified workforce. 
• Organizational capacity to support culturally competent services and ongoing improvement efforts. 
• Health care safety net for hospital admissions of vulnerable populations.

Infrastructure Measures 

• Physicians and surgeons per 100,000 population, by race and ethnicity, 2006-2013. 
• Primary care medical residents per 100,000 population, by sex and ethnicity, 2012-2013. 
• Characteristics of HRSA-supported health center population versus U.S. population, 2013. 
• Medicaid and uninsured discharges in U.S. short-term acute hospitals, by facility characteristics, 2012.

Rate of Physicians and Surgeons per 100,000 Population

Physicians and surgeons per 100,000 population, by race and ethnicity, 2006-2013 

Left Chart:

Right Chart:

Key: AI/AN = American Indian or Alaska Native.

Data Source: U.S. Census, American Community Survey, 2006-2013.

Note: The 2008 and 2013 data for AI/ANs did not meet the criteria for statistical reliability, data quality, or confidentiality. White and Black are non-Hispanic. Hispanic includes all races.

Groups With Disparities:

• From 2006 to 2013, the rate of physicians and surgeons per 100,000 population was higher for Asians than for Whites, Blacks, and American Indians and Alaska Natives. 
• From 2006 to 2013, the rate of physicians and surgeons per 100,000 population was higher for non-Hispanic Whites than for non-Hispanic Blacks. Lower rates were observed in Hispanic physicians and surgeons from 2007 to 2013.

Rate of Primary Care Residents per 100,000 Population

Primary care medical residents per 100,000 population, by sex and race/ethnicity, 2012-2013 

Left Chart:

Right Chart:

Key: AI/AN = American Indian or Alaska Native; API = Asian or Pacific Islander.

Data Source: Accreditation Council for Graduate Medical Education, Data Resource Book, Academic Year 2012-2013. http://www.acgme.org/acgmeweb/tabid/259/Publications/GraduateMedicalEducation DataResourceBook.aspx 

Note: White, Black, API, and AI/AN are non-Hispanic. Hispanic includes all races. Rates are based on American Community Survey 1-year population estimates for 2012.

Groups With Disparities:

• From 2012 to 2013, the rate of primary care medical residents was higher for females than for males in family medicine, obstetrics and gynecology, and pediatrics. The rate for males was higher than for females in internal medicine. 
• From 2012 to 2013, the rate of primary care medical residents was higher for Asians and Pacific Islanders than for all other racial/ethnic groups, with the highest rate in internal medicine. Lower rates were observed for Hispanic primary care residents.

Characteristics of HRSA-Supported Health Center Population

Characteristics of HRSA-supported health center population versus U.S. population, 2013 

Key: AI/AN = American Indian or Alaska Native; NHOPI = Native Hawaiian or Other Pacific Islander; FPL = Federal poverty level.

Data Source: Health Resources and Services Administration, Bureau of Primary Health Care, Uniform Data System, 2013. http://bphc.hrsa.gov/uds/datasnapshot.aspx?year=2013

Note: Racial groups include Hispanics and non-Hispanics. Health center population includes 1,202 program grantees data only.

Groups With Disparities:

• In 2013, 71.9% of the health center population was at or below the Federal poverty level compared with 15% of the U.S. population. The health center population also had higher percentages of uninsurance (34.9%) and Medicaid enrollment (41.5%) than the U.S. population (15.4% and 16.4%, respectively).
• In 2013, slightly more than one-third (34.8%) of the health center population was Hispanic, which was twice as much as the percentage in the U.S. population (17.1%). The percentage of Blacks at the health centers was nearly one-quarter (23.8%), nearly twice as much as the percentage in the U.S. population (12.2%).

Medicaid and Uninsured Discharges in Short-Term Acute Hospitals

Medicaid and uninsured discharges in U.S. short-term acute hospitals, by facility characteristics, 2012 

Data Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, HCUPnet, 2012.

Groups With Disparities:

• In 2012, 28.5% of Medicaid and uninsured patients were discharged from private, for profit hospitals compared with 36.2% from government hospitals.
• Compared with hospitals with 500 or more beds (28.9%), hospitals with bed sizes under 300 (23.4% for <100 beds and 25.2% for 100-299 beds) had a smaller percentage of Medicaid or uninsured patients. 
• The percentage of patients discharged from teaching hospitals who were uninsured or covered by Medicaid was 28.3%, compared with 24.5% of patients in nonteaching hospitals. 
• Hospitals in the West discharged a greater percentage of Medicaid and uninsured patients (28.7%), while hospitals in the Midwest discharged the lowest percentage of these patients (23.2%).

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