The Institute of Medicine's report on racial and ethnic disparities noted that factors such as ability to pay or insurance are the most significant barriers to equitable care and """"""""must be addressed as an important first step to eliminating disparities."""""""" In this research core we will examine the impact of such primary barriers on racial and ethnic disparities in access to health care. The core will consist of seven investigators including physicians-investigators from various disciplines, health policy and health service researchers and economists. All have established programs of research in financial barriers to care and have funded projects examining minority populations. This research core will focus on five specific areas: (1) monitor ongoing trends in health insurance and how such barriers affect disparities in the areas of mental health, diabetes care, and cardiovascular disease; (2) the contribution of additional financial barriers to racial and ethnic disparities among the insured population; (3) whether changes in the health care system during the 1990s helped reduce or worsen existing racial and ethnic disparities in access to care; (4) how future changes in the health care delivery system may affect disparities; (5) the impact of primary access barriers on the health care systems that deliver care to persons in minority communities. To achieve these aims, we will: (a) establish a resource center for interdisciplinary studies consisting of a data repository of the diverse datasets used by individual members of this core and a data manager who will serve as a local expert on these datasets; (b) form collaborations between core investigators who are leading experts in primary barriers among minority populations and the community-based organizations that are developing products to help residents in northern Manhattan overcome such financial barriers; (c) facilitate cross-fertilization of ideas and methodological approaches to carry out investigations within the specific focus areas of investigations under this core.
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