Racial-Ethnic Differences in Healthcare Experience Among Middle-Aged and Older Adults in the United States: Evidence From Four Waves of the Health and Retirement Study.

Abstract

ObjectivesRacial and ethnic inequities in U.S. healthcare extend beyond insurance and access, yet less is known about how they vary across domains of healthcare experience and whether public insurance mitigates these inequities.MethodsUsing four waves (2014-2020) of Health and Retirement Study data (n = 16,088), this study examines disparities in satisfaction, affordability, accessibility, and preference concordance among middle-aged and older adults.ResultsResults show domain-specific disparities: Black, Hispanic, and "Other" respondents had higher odds of unmet healthcare preferences than non-Hispanic White respondents, while affordability gaps persisted. Differences in overall satisfaction were largely attenuated after adjustment, whereas Black respondents reported fewer accessibility barriers. Medicaid mitigated some disparities, particularly for Hispanic respondents in affordability and preference concordance, whereas Medicare showed limited moderating effects, with gains in satisfaction being more evident among non-Hispanic White respondents.DiscussionOverall, inequities persist beyond socioeconomic and health differences, highlighting structural and interpersonal factors in shaping healthcare experiences.