Researchers analyzed data from 29 nationally representative surveys of health care use and expenditures by and on behalf of non-Hispanic Black and non-Hispanic white individuals of all ages in the civilian, noninstitutionalized U.S. population from 1963 through 2019. Among the findings:

• White people's overall health care use (measured as expenditures by or on behalf of individuals) exceeded that of Black people in every year.
• After initially narrowing from the 1960s to the 1970s, the expenditure ratio began widening again in the 1980s.
• The absolute white-Black per capita expenditure gap was $1,880 from 2014 to 2019, larger than during any other period.
• Rates of ambulatory care visits decreased in the 1970s and began increasing in the 1980s.
• Large disparities in dental visits increased between the 1970s and 1990s and then narrowed slightly from 2014 to 2019.
• As in the past, Black people currently have slightly more emergency department visits per year.
• White people spend slightly more days as inpatients in hospitals.
• The racial differences could represent underuse by Black individuals, overuse by white individuals or both.
• A much greater percentage of Black than white people in the United States are uninsured, and more Black adults report skipping needed care because of costs.

"The persistence of large racial gaps in the amounts of medical care delivered to white and Black patients in the United State suggests that structural racism is ingrained in the health care system," the study concluded. "The widening racial-ethnic gap in life expectancy during the COVID-19 pandemic further highlights the urgency of reforms that promote racial equity. Policies to equalize financial access to care would likely bridge some of the gaps, but additional steps will also be required.

"Addressing shortages of Black health care professionals and managers, investing in Black-serving medical facilities, increasing community outreach efforts and enacting other measures that help earn black patients' trust in the health care system could also promote equity. Healing the persistent racial divide in medical care in the United States would contribute to and benefit from measures to mend the social and economic schisms of race."