Racial differences in physician usage among the elderly poor in the United States

Despite the rapidly growing ranks of the elderly in America, the increasing racial and ethnic diversity of this population, and the large number of seniors who are poor, there are relatively few systematic investigations that examine the causes of racial differences in health care use specifically among elders living in poverty. This article addresses this issue by examining differences in patterns of having and using a physician among the elderly poor, the role that race plays and what might explain it. We demonstrate that even within this disadvantaged and medically engaged population there are persistent and significant racial differences in having and using a doctor. Specifically, we show: (1) Whites and women are more likely to have a regular doctor than men and African Americans; (2) Among those who have a doctor, whites and women also visit the doctor with greater frequency than other groups even at the same levels of health or illness; (3) After accounting for the varying levels and effects of social connectedness, racial differences in having a doctor essentially disappear; and (4) While differences in having a regular doctor can be accounted for using measures of social connectedness, substantial and robust racial and gender differences in doctor use remain. In the end, we provide an analysis that examines typical factors known to influence health care use, and find that while need, structural factors, perceptions of care, and social connectedness have a powerful effect on doctor visits, the racial variation in using a doctor cannot be explained away with the available measures.