Health Care Utilization

Utilization Patterns

In general most ethnic minority populations use formal health care services for mental health and long term care less than their white counterparts. Since 2000, however, rates of nursing home utilizations by African Americans has been slightly higher than Whites.

Emergency rooms and acute care tend to have higher utilization.

Barriers to Utilization (Damron-Rodriguez et al., 1994)

Availability

Services not available where ethnic elders live:
  1. Sometimes a problem for primary care
  2. A more common problem for specialty care
  3. Most common for long-term care
  4. Will require policy advocacy to effect change

Accessibility

Care is available, but the elder cannot use it for a variety of reasons:
  1. Lack of knowledge of services or interest in care
  2. Distrust of the system
  3. Fear of punitive action (immigration status or loss of benefits)
  4. Inability to deal with bureaucracy
  5. Assumptions by providers of lack of motivation or interest
  6. Being victims of elder abuse or mistreatment (See also Assessment)
  7. Transportation difficulties
Financial and eligibility constraints:
  1. Limited income
  2. Lack of eligibility for service
  3. Co-payments or small charges can discourage the poor
Discrimination
  1. Discourages use of services
Language barriers
  1. Lack of available interpreters
  2. Isolation of monolingual non-English speaking elders in residential and day care settings
  3. Acts as disincentive to use of assisted living/board and care or nursing homes

Acceptability is the aspect of care most affected by culture.

Acceptability

  1. Based on patients’ satisfaction and having their expectations met
  2. Aspect of care most affected by culture
  3. Interaction between patient expectations and provider performance
  4. Most are amenable to change by individual providers
  5. Depends upon trust between provider and patient
  6. Changes in providers reduce acceptability
  7. Managed care can limit degree of acceptability
  8. Perception of “welfare” decreases acceptability for some who see publicly
  9. Care of other family member may have priority over accessing care