Health care works better for North Carolina’s white residents than for everyone else

Health care access for North Carolina’s Latino residents is among the worst in the nation, according to a Commonwealth Fund report on racial health care disparities. 

The report measures the ability of people of different races and ethnicities to obtain health care, the quality of the care they receive, and how healthy they are. It uses 25 indicators to detail racial disparities in health care systems in each state. 

In North Carolina and most states, health care systems work best for white people.

“In almost every state, health system performance experienced by white people is better than the average performance for all groups,” David Radley, a senior scientist at the Commonwealth Fund, said at a video news conference Wednesday.

The rates of uninsured Latino adults and children in North Carolina are higher than national rates, and adults are far less likely to have a usual source of care than any other racial or ethnic group in the state. 

Despite the lack of healthcare access for Latinos in North Carolina compared to the rest of the country, health outcomes for the state’s Latino residents are among the best in the country. 

In an email, Radley said that it’s been noted that, particularly among Latino residents, health outcomes can be good even when insured rates are low.  

“There has been some academic work on this phenomenon, and while there are no definitive answers, the explanations offered tend to focus on the relative young age of Hispanic populations and how different Hispanic populations may be from state to state,” Radley wrote.  

Researchers call the phenomenon of better health despite lack of health care access “the Hispanic paradox.”

“On average, Hispanic people in the U.S. are younger than most other groups, this can certainly impact mortality statistics. Even across states, Hispanic populations may vary somewhat in age.” 

North Carolina ranks first for health system performance for Native Americans in the group of 10 states where calculations are possible. 

Even when health system performance for Native Americans or Black residents ranks high compared to other states, the ratings remain below states’ best performance scores. For example, North Carolina’s white residents have a health care performance score of 82, while Native Americans have a performance score of 28. 

Health system performance for Asian Americans and Pacific Islanders in North Carolina was worse than average compared to other states, but better than the national median for all groups. 

In most states, including North Carolina, Black and Native American residents are more likely to die before age 75 from preventable causes that are treatable by timely access to health care. The death rate for white North Carolina residents from preventable causes is also higher than the national rate, but a disparity still exists. 

Racial and ethnic disparities in health and health care are evident in every state, even those with strongly performing health systems, said Arnav Shah, a senior research associate with the Commonwealth Fund. “Health care system performance is particularly worse for Black, Hispanic, and Native American populations, meaning these groups have more problems accessing care, the quality of care they get is lower, and they have the worst health outcomes when compared to white people in many states,” he said. 

The Commonwealth Fund has been tracking health system performance in the United States since 2006. It releases scorecards every year. The report released Thursday reflects data collected in 2021 and 2022. Any effect of Medicaid expansion in North Carolina, which launched in December of last year, is not captured in data. 

Policy changes are needed to address the inequities, the report says. 

Ensuring affordable, comprehensive, and equitable insurance for all is key, said Laurie Zephyrin, a senior vice president for advancing health equity at the Commonwealth Fund. 

“Even for people who are insured, about a quarter of working age adults are underinsured. They’re really facing high out-of-pocket costs and deductibles relative to their income, which really makes them not come in for care at all because they can’t afford it.”

The Commonwealth Fund recommends more investments in primary care. “Black and Hispanic communities have fewer health care providers,” Zephyrin said, making it important to address insurance reimbursements and expand the workforce.