Social Determinants of Access to Healthcare Services in the Tri-County Charleston Metropolitan Area, South Carolina, by Race and Ethnicity

Background: Despite an overall increase in insurance coverage in the Tri-County Charleston Metropolitan Area (Tri-County Area) in South Carolina, the number of premature deaths increased between the years of 2015 to 2020. In addition, racial and ethnic disparities in health outcomes and deaths persist.

Objective: Employ the 2019 Community Health Needs Assessment Report conducted by Trident United Way in conjunction with the Medical University of South Carolina and Roper St. Francis Hospital to assess differences in access to healthcare and self-reported reasons for limited healthcare access by race and ethnicity.

Methods: Reasons for limited healthcare access included cultural/religious beliefs, not knowing how to access services, not knowing when to see a doctor, fear, lack of trust, lack of available services, no insurance, cost, not knowing how to sign up for insurance, lack of transportation, work schedule, distance or safety to access health services, lack of knowledge, or other. Race and ethnicity was categorized as White, Hispanic, Black and Other. Rao-Scott Chi Square tests were used in Excel to conduct all analyses.

Results: Statistically significant differences between race and ethnicity were found for all but four reasons for limited healthcare access. Significant results indicated a difference by race and ethnicity for the following reasons for limited healthcare access: “Cultural/religious beliefs” (p=<.0001); “I don’t know how to access healthcare services (p=.034); “I do not know when I need to see a doctor” (p=.006); “Fear” (p=.010); “I do not trust doctors'' (p=.003), “I do not have insurance and cannot pay for services (<.001); “I have insurance, but I cannot afford the co-pay or deductibles” (p<.001); “I do not know how to sign up for health insurance” (p<.001); “Lack of transportation” (p<.001); and “Lack of knowledge” (p<.001). No significant difference was found for lack of available healthcare services or distance to healthcare services.

Conclusions: Findings indicate that many disparities exist by race and ethnicity in reasons for limited healthcare access in the Charleston Tri-County area. It is interesting that no differences were found in terms of availability of services or distance to services, indicating that other strategies are needed to increase access to care. Further research with a community-based collaborative approach is needed to address these barriers to care.