At the societal level, distal costs follow from proximal opportunities that were missed to intervene and reduce burden of illness. For example, end-stage renal disease may result from longstanding poorly controlled diabetes. The highly morbid and highly costly condition could potentially be avoided with access to indicated services and effective management of diabetes. Without screening, cancers may not be detected until they grow large or metastasize to distant sites and cause symptoms. Such late stage cancers are usually associated with more limited treatment options and poorer survival. Minorities and persons of lower socioeconomic status are less likely to receive cancer screening services and more likely to have late stage cancer when the disease is diagnosed.


Persons with diabetes of lower socioeconomic position are less likely to receive recommended diabetic services and more likely to be hospitalized for diabetes and its complications. Many racial and ethnic minorities and persons of lower socioeconomic position are less likely to receive recommended immunizations for influenza and pneumococcal pneumonia, the most common type of pneumonia. Once hospitalized, some ethnic and racial minorities, as well as lower income patients, suffer worse quality of care for pneumonia. These differential rates of vaccination and hospitalization present opportunities for provider-based and community-based interventions to reduce disparities.


Differential access may lead to disparities in quality Access to healthcare is an important prerequisite to obtaining quality care. Some access barriers, whether perceived or actual, can result in adverse health outcomes. Patients may perceive barriers to delay seeking needed care, resulting in presentation of illness at a later, less treatable stage of illness. For example, a usual source of care can serve as a navigator to the healthcare system and an advocate to obtain needed evidence-based preventive and health care services.  Of the major measures of access, the lack of health insurance has significant consequences.


Avoidable hospitalizations are a good example of the link between access and disparities in quality of care. These hospitalizations may reflect, in part, the adequacy of primary care. When health care needs are not met by the primary health care system, rates of avoidable admissions may rise. In contrast, perceived problems with specialty referral do not have clear clinical consequences.


Many racial and ethnic minorities and individuals of lower socioeconomic status are less likely to have a usual source of care. Hispanics and people of lower socioeconomic status are more likely to report unmet health care needs While most of the population has health insurance, racial and ethnic minorities are less likely to report health insurance compared with whites.


income persons are also less likely to report insurance compared with higher income persons. Higher rates of avoidable admissions by blacks and lower socioeconomic position persons may be explained, in part, by lower receipt of routine care by these populations.