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October 25, 2000

Inequalities in Racial Access to Health Care—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(16):2053. doi:10.1001/jama.284.16.2053

In Reply: Drs Hoeldtke and Hoeldtke suggest that, in some instances, disparities in access to health care services favor minorities. Using the example of abortion, they suggest that African Americans have greater access and use of health care than do whites. Instances of higher use patterns by minorities are instructive. At first glance, they suggest greater access to selected health care services for minorities, but on careful examination, they often show a pattern of reduced access to earlier, preventive care. Thus, higher abortion rates among African Americans may reflect higher rates of unwanted pregnancies and reduced access to pregnancy prevention services. Other notable examples of this pattern include greater use of hemodialysis, hospital emergency departments, human immunodeficiency virus testing, and neonatal intensive care by African Americans.1-4 In each case, greater use reflects, at least in part, reduced access to primary and preventive care. Indeed, higher use of health care services by minorities merits attention by hospitals and health maintenance organizations. Like traditional patterns of use, higher patterns represent unique opportunities for quality improvement.