The effects of gender and race/ethnicity on predicting health care service utilization by older Americans

Although Medicare has improved the overall health status and health care for older Americans, access to health care still varies by gender and race/ethnicity (Suro, 2000; U.S. Public Health Service, 2001; Federal Interagency Forum on Aging and Related Statistics, 2000). Older ethnic minorities are more likely to face barriers in obtaining health care than white elders. This is a concern because these individuals tend to be poorer and sicker (Escarce & Puffer, 1997). With the demographic factors of the older population becoming increasingly female and racially and ethnically diverse, the demand will increase for a health care system that addresses the care needs of an ethnically diverse population of elders. To best prepare for these demands, the nature and predictors of these elders' health care needs and service use warrants study.;This study examines health care service use as an indicator to measure access to health care. In particular, the focus of this study is acute and chronic health care services covered by Medicare and utilized by non-institutionalized, community-dwelling older Americans 65 years and older. The various domains of health care services chosen for this study reflect the importance of medical, nursing, and social services to meet the needs of elders as they go through the stages of wellness to illness. While group comparisons using gender and race/ethnicity are common, the majority of research on health care is based on the dichotomous comparisons (African Americans and non-Hispanic whites or men and women). These studies may mask significant intragender patterns or intraracial/ethnic differences. This study addresses this concern through consideration of gender and race/ethnicity as predictors singularly and in interaction.;Central findings are as follows: (1) Gender did not have a significant main effect for service use, but it was significant when treated as interactive terms with race/ethnicity (number of hospital admissions and number of home health care visits); (2) Race main effect was significant for general physician care, ER care, hospital care, number of hospital admissions, and number of home health care visits; (3) Having supplemental insurance, one of the finance-related enabling factor, was found to be significant for use of specialist care, ER care, and home health care; (4) The level of acculturation was significant for specialist care and number of hospital stays; and (5) Regions where elders reside (Northeast, South, Midwest, West) were strong predictors of service use. Findings point to the heterogeneity of service use by race/ethnicity and gender, and the persisting problems of health care access among older women and race/ethnic minority groups.