Racial/ethnic differences in access to health care: further comments on the use-disability ratio

Indicators of access to health care generally fall into one of two broad groups. The first group of indicators focuses on factors responsible for differential rates of use and often are assessed through reports of patient satisfaction. The second group of indicators focuses more specifically on actual rates of use, and therefore represents a more objective measure of access. One of the most widely used objective indicators of access is the use-disability ratio. This article illustrates some problems in using this ratio in health services research and some strategies one might adopt to minimize these problems. The data reported below were obtained from an analysis of racial/ethnic differences in use of services that was conducted as part of the 1979 Los Angeles Health Survey (N = 1003). Our findings suggest that 1) blacks had greater access to health care than either white/Anglos or Hispanics, particularly for respiratory and musculo-skeletal problems, and 2) the use-disability ratio should be used cautiously, since it is sensitive to subgroup differences in the chronicity and cause of the disability