Measuring Racial/Ethnic Disparities in Health Care: Methods and Practical Issues

• Published in: Health services research Vol. 47; no. 3pt2; pp. 1232 - 1254
• Main Authors: Cook, Benjamin Lê, McGuire, Thomas G., Zaslavsky, Alan M.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.06.2012; Health Research and Educational Trust; Blackwell Science Inc
• Subjects: Analysis; Clinical outcomes; Cultural differences; Discrimination in medical care; Ethnic differences; Ethnicity; Health care; Health care disparities; Health costs; Health inequalities; Health services; Health Services Accessibility - organization & administration; Health Services Accessibility - statistics & numerical data; Health Services Research - methods; Healthcare Disparities - ethnology; Healthcare Disparities - statistics & numerical data; Humans; Indigent care; Medical care discrimination; Mental health; Mental health care; Mental health services; Minority & ethnic groups; Prejudice; Psychiatric services; Quality management; Racial differences; Racial Groups; Research Design; Residence Characteristics; Socioeconomic Factors; Sociology, Medical; Special Issue: Measuring and Analyzing Health Care Disparities; Studies; United States
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/j.1475-6773.2012.01387.x

Objective To review methods of measuring racial/ethnic health care disparities. Study Design Identification and tracking of racial/ethnic disparities in health care will be advanced by application of a consistent definition and reliable empirical methods. We have proposed a definition of racial/ethnic health care disparities based in the Institute of Medicine's (IOM) Unequal Treatment report, which defines disparities as all differences except those due to clinical need and preferences. After briefly summarizing the strengths and critiques of this definition, we review methods that have been used to implement it. We discuss practical issues that arise during implementation and expand these methods to identify sources of disparities. We also situate the focus on methods to measure racial/ethnic health care disparities (an endeavor predominant in the United States) within a larger international literature in health outcomes and health care inequality. Empirical Application We compare different methods of implementing the IOM definition on measurement of disparities in any use of mental health care and mental health care expenditures using the 2004–2008 Medical Expenditure Panel Survey. Conclusion Disparities analysts should be aware of multiple methods available to measure disparities and their differing assumptions. We prefer a method concordant with the IOM definition.