Race/Ethnicity, educational attainment, and foregone health care in the United States in the 2007-2009 recession

• Published in: American journal of public health (1971) 2014-02, Vol.104 (2), p.e134-e140
• Main Authors: Burgard, Sarah A, Hawkins, Jaclynn M
• Format: Article
• Language: English
• Subjects: Access To Care; Adult; Asian Americans; Continental Population Groups - statistics & numerical data; Dental Care - utilization; Economic Recession - statistics & numerical data; Educational attainment; Educational Status; Ethnic Groups - statistics & numerical data; Ethnicity; Female; Health care; Health insurance; Health Services - utilization; Health Surveys; Healthcare Disparities; Humans; Insurance coverage; Male; Mental Health Services - utilization; Middle Aged; Minority & ethnic groups; Older people; Online Research and Practice; Prescription Drugs; Public health; Race; Race/Ethnicity; Recessions; Social Determinants of Health - statistics & numerical data; Socioeconomic Factors; Studies; United States
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2013.301512

This study assessed possible associations between recessions and changes in the magnitude of social disparities in foregone health care, building on previous studies that have linked recessions to lowered health care use. Data from the 2006 to 2010 waves of the National Health Interview Study were used to examine levels of foregone medical, dental and mental health care and prescribed medications. Differences by race/ethnicity and education were compared before the Great Recession of 2007 to 2009, during the early recession, and later in the recession and in its immediate wake. Foregone care rose for working-aged adults overall in the 2 recessionary periods compared with the pre-recession. For multiple types of pre-recession care, foregoing care was more common for African Americans and Hispanics and less common for Asian Americans than for Whites. Less-educated individuals were more likely to forego all types of care pre-recession. Most disparities in foregone care were stable during the recession, though the African American-White gap in foregone medical care increased, as did the Hispanic-White gap and education gap in foregone dental care. Our findings support the fundamental cause hypothesis, as even during a recession in which more advantaged groups may have had unusually high risk of losing financial assets and employer-provided health insurance, they maintained their relative advantage in access to health care. Attention to the macroeconomic context of social disparities in health care use is warranted.