Cost-Related Non-Utilization of Health Services and Self-Perceived Reactions to Race

There is limited information regarding the prevalence and predictors of cost-related non-utilization (CRNU), while there is increasing attention to the rising out-of-pocket cost of health services including prescription medications. Prior studies have not quantified the role of perceived racism despite its documented relationship with health services utilization. We examine perceptions of reactions to race and quantify their relationship with CRNU.

This retrospective cross-sectional study utilized data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) public use file, an annual, state-based telephone survey of US adults aged 18 and older. We utilized data for four states that provided responses to five Reactions to Race items, including information about the self-perceived quality of the respondent's health care experience compared with people of other races (worse vs same or better) and whether the respondent experienced physical symptoms because of treatment due to their race. The three binary outcomes were: 1) did not visit a physician; 2) did not visit a physician due to cost; 3) did not fill a prescription due to cost. We estimated covariate-adjusted odds ratios associated with each outcome using logistic regression models.

The BRFSS sample consisted of 20,366 respondents of whom 8% were African American non-Hispanic, 12% were Hispanic and 73% were White. Three percent of respondents considered their experience to be worse than people of other races. Three percent of individuals reported physical symptoms because of treatment due to their race while 5% of respondents reported becoming emotionally upset because of treatment due to their race. The proportions for the three study outcomes were 11%, 13% and 7%, respectively. In covariate-adjusted models, a worse experience with the health care system was statistically significantly associated with CRNU (physician visit: 2.6 [95% CI: 1.6 - 4.3]). The experience of physical symptoms because of treatment due to race was statistically significantly associated with CRNU (physician visit: 2.6 [95% CI: 1.7 - 4]; prescription fills: 2.1 [1.2 - 3.6]). No Reactions to Race items were associated with general non-utilization.

Negative perceptions of reactions to race during the time of health services utilization is positively associated with CRNU, ie, foregoing physician visits and prescription fills due to cost.