Is there equity in the home health care market? Understanding racial patterns in the use of formal home health care.

Abstract

This article explores whether the formal home health care (HHC) market is equitable or manifests unexplained racial disparities in use. The database is the 1994 National Long Term Care Survey. We estimate logit regression models with a race dummy variable, race interaction terms, and stratification by race. We apply the Oaxaca decomposition technique to quantify whether the observed racial gap in formal HHC use is explained by racial differences in predisposing, enabling, need, and environmental characteristics. We find numerous unique racial patterns in HHC use. Blacks with diabetes and low income have higher probabilities of HHC use than their White counterparts. Black older persons have a 25% higher chance of using HHC than Whites. Our Oaxaca analysis indicates that racial differences in predisposing, enabling, need, and environmental characteristics account for the racial gap in use of HHC. We find that the HHC market is equitable, enhancing availability, acceptability, and accessibility of care for older Black persons. Thus, the racial differences that we find are not racial disparities.