Access barriers related to communication problems may be particularly acute for the subset of Latino patients for whom Spanish is the primary language. However, language issues do not fully account for access barriers faced by Latinos. In the study of emergency department pain medication cited previously, even Latinos who spoke English as their primary language were much less likely than non-Latino whites to receive pain medication. ++ Because many of these hypotheses do not satisfactorily explain the observed racial and ethnic disparities in access to care, an important consideration is whether racism may also contribute to these patterns (King & Wheeler, 2016).

Neighborhoods that have high proportions of African-American or Latino residents have far fewer physicians practicing in these communities. African-American and Latino primary care physicians are more likely than white physicians to locate their practices in underserved communities (Komaromy et al., 1996; Marrast et al., 2014).

Because a far higher proportion of minorities than whites is uninsured, has Medicaid coverage, or is poor, access problems are amplified for these groups. In 2016, African American, Latino, Asian, and American Indian adults were twice as likely as whites to report difficulty obtaining a timely medical appointment for illness or injury. Analyzing a group of quality measures in 2014–16, African Americans received worse care than whites for 40% of these quality measures and Latinos and American Indians received worse care than whites for about one-third of the indicators. While some inequities in access and quality, such as adolescent immunization rates, have decreased over the past 15 years, others have widened, such as disparities in blood pressure control among African Americans relative to other groups (U.S. Agency for Healthcare Research and Quality, 2017). Overall, there has been a clear lack of progress on health equity over the past 25 years (Zimmerman and Anderson, 2019)