Healthcare utilization varies by race/ethnicity among low-income Baltimore residents with the same insurance coverage

African American and Hispanic/Latino patients experience disparities in health outcomes compared to non-Hispanic Whites. Data suggest that these disparities in outcomes may be partially explained by barriers to healthcare utilization, like insurance coverage. Several studies have shown that people who are uninsured and underinsured are less likely to seek healthcare than those with insurance, and that racial/ethnic minorities are more likely to be un/underinsured than Whites. Less is known, however, about variation in healthcare utilization by race/ethnicity among patients with the same insurance coverage. The Access Partnership (TAP) is an initiative of the Johns Hopkins network that guarantees coverage of primary and specialty care appointments to un/underinsured patients residing in one of seven target zip codes in Baltimore City and demonstrating financial need. No research has been done into variations by ethnicity among TAP patients. This study employed a cross-sectional design using secondary data extracted from an administrative database. It measured variation by race/ethnicity in counts of medical appointments among TAP enrolled patients of Johns Hopkins Hospital and Bayview Medical Center. Demographic and appointment data was extracted from DataMart. Participants included in the analysis were 817 low-income patients of the Johns Hopkins clinical network, residing in Baltimore City and enrolled in The Access Partnership insurance program between May 2009 and February 2012. Patients were excluded if we had difficulty finding a unique medical record, if they had no appointments billed to TAP, and if they had erroneous appointment counts. Poisson regression, controlling for days eligible for TAP coverage, was used to measure the effects of the covariates (race/ethnicity, sex, age, and zip code) on the outcome variables (number of appointments and total charges). Appointment rate was calculated using the continuous count of appointments over days with TAP insurance coverage. Multivariate statistical analysis, employing a quasi likelihood adjustment, showed significantly lower rates of appointments among African American and Hispanic/Latino patients than Non- Hispanic Whites. African American NH patients were only 0.58 times (95% CI: 0.45, 0.76) as likely as White patients to have an appointment and Hispanic patients were 0.38 times (95% CI: 0.28, 0.50) as likely as White patients to have an appointment. The results suggest that even among patients with equivalent insurance coverage for healthcare, racial/ethnic disparities persist in healthcare utilization as measured by appointment rate. Further research is warranted to understand how these trends are affected by time with expanded insurance coverage and type of medical visits.