Barriers to and use of Health Care Among American Indians and Alaska Natives in Urban Areas: Findings from the National Health Interview Survey (2006-2009)

BACKGROUND:  Health disparities for American Indians/Alaska Natives (AI/ANs) compared to non-Hispanic whites (NHWs) may be explained, in part, by access to and use of health care. Studies have indicated that gaps exist in access to and use of healthcare for AI/ANs, however less is known about AI/ANs in urban areas, where factors affecting health care may differ. 

METHODS:  We examined access to and use of health care services among urban AI/ANs in National Health Interview Survey data (2006-09). Non-Hispanic whites were used as the comparison group. We further examined whether access to and use of health care are driven by health insurance, income or self-reported health status among these groups using adjusted stratified analyses. 

RESULTS:  Significant disparities exist for urban AI/ANs compared to urban NHWs in nearly all areas examined, including in adjusted stratified analyses (not listed here). More AI/ANs lack health insurance than NHWs (40% vs. 12%, respectively; p <0.001); and more cited cost as the reason (60% vs. 46%, respectively; p <0.001). Additionally, more AI/ANs reported not being able to afford needed medical care (15% vs. 7%, respectively; p <0.001) or delaying care due to long waits at the doctor’s office (10% vs. 4%, respectively; p <0.001). More AI/ANs reported having not talked with a health care professional in the past year or more (27% vs. 14%, respectively; p <0.001) and fewer had a usual place to go when sick compared to NHWs (75% vs. 87%, respectively; p <0.001). 

CONCLUSIONS: Urban AI/ANs have increased barriers to health care access and decreased use of health care services compared to NHWs. As U.S. policymakers focus their attention on health care reform, understanding the magnitude of disparity and barriers for urban AI/ANs is critical to ensuring equitable access to care for this population.