Hispanics and the Future of America (2006) / Chapter Skim
Currently Skimming:
10 Access to and Quality of Health Care--José J. Escarce and Kanika Kapur
10 Access to and Quality of Health Care--José J. Escarce and Kanika Kapur
Pages 410-446
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From page 410... ...
Low-income people are less able to afford the out-of-pocket costs of care, even if they have health insurance coverage. Low education may impair people's ability to navigate the complex health care delivery system, communicate with health care providers, and understand providers' instructions.
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From page 411... ...
Among Hispanics who are not citizens, a sizable number are undocumented immigrants. These features of the Hispanic population have both direct effects on reducing access to health care and indirect effects through their association with lower rates of health insurance coverage.
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From page 412... ...
Without health insurance coverage, many people find health care unaffordable and forgo care even when they think they need it. Having a usual source of care reduces nonfinancial barriers to obtaining care, facilitates access to health care services, and increases the frequency of contacts with health care providers.
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From page 413... ...
Among workers, rates of employer-provided insurance coverage were 48 and 77 percent for Hispanic and white males, respectively, and 61 and 80 percent for Hispanic and white women. Hispanic male and female workers were less likely than their white counterparts to be offered health insurance by their employers (56 versus 81 percent or males and 62 versus 75 percent for females)
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From page 414... ...
, provide health insurance coverage to many low-income Hispanics. Nonetheless, these programs are not sufficient to close the health insurance gap between Hispanics and non-Hispanic whites.
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From page 415... ...
. Of note, PRWORA is unlikely to have affected Puerto Ricans, since they are U.S.
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From page 416... ...
However, Puerto Ricans are much more likely than Cubans to rely on Medicaid or SCHIP as sources of health insurance coverage. As anticipated, nativity, time since arrival in the United States, and citizenship are associated with health insurance coverage (Table 10-2)
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From page 417... ...
rate of Medicaid coverage than those who prefer English; as a result, the difference in uninsured rates by language preference is much smaller for Puerto Ricans than for the other groups. Usual Source of Care Not having a usual source of health care is another key barrier to health care access.
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From page 418... ...
usual source of care reduces barriers to care that may arise from the difficulty and cost of searching for a health care provider. Familiarity with a particular provider may also make people more comfortable in seeking care, make it easier to make appointments at convenient times, and reduce
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From page 419... ...
, and more than one-third of immigrants lack a usual source. Furthermore, among Hispanics, Spanish speakers are less likely than English speakers to
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From page 420... ...
For Puerto Ricans, by contrast, language preference is unassociated with having a usual source of care, although Puerto
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From page 421... ...
Ricans who prefer English are more likely than those who prefer Spanish to have a physician's office as their usual source. Other Barriers An important structural barrier to health care access faced by many Hispanic patients is distance to medical care providers, in general, coupled
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From page 422... ...
62 14 20 1 3 1,051 > 5 years in U.S. 36 38 24 1 1 4,614 Noncitizen 47 27 23 1 2 4,594 Citizen 26 51 20 1 2 1,412 Puerto Rican U.S.-born 17 57 23 2 1 1,261 Foreign-born 14 56 27 2 1 1,244 < 5 years in U.S.
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From page 423... ...
(%) Number All Hispanics English 21 57 19 1 1 13,587 Spanish 39 35 23 1 1 9,409 Mexican English 25 55 18 1 1 7,380 Spanish 45 30 23 1 1 5,903 Puerto Rican English 15 59 23 2 1 1,953 Spanish 15 48 34 2 0 500 Cuban English 14 72 11 2 2 390 Spanish 22 66 11 1 1 744 Other Hispanics English 20 59 18 1 1 3,864 Spanish 36 35 25 3 1 2,262 SOURCE: 19972001 NHIS.
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From page 424... ...
And 13 percent of Hispanics, compared with 1 percent of whites, reported personally experiencing unfair treatment. These barriers to health care access may have profound effects on Hispanic patients' decisions to seek care.
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From page 425... ...
. Prenatal care may also provide an entry point to the health care system, especially for women who do not have a usual source of care.
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From page 426... ...
Lack of health insurance coverage may make prenatal care unaffordable for many Hispanic women. Additional barriers are likely to include language and cultural incompatibility between women and their prenatal care providers, lack of understanding or knowledge of prenatal care, and fear of the effect of seeking care on immigrant status.
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From page 427... ...
And 55 percent of Hispanic seniors reported receiving a flu shot during the preceding 12 months, compared with 67 percent of whites and 47 percent of blacks. Working-age Hispanic women lag both non-Hispanic white and nonHispanic black women in the rates of mammography and pap smears (National Center for Health Statistics, 2003)
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From page 428... ...
Using MEPS, Stewart and Silverstein (2002) found that Hispanics were less likely than whites and blacks to have a blood pressure or cholesterol screening, although the differences in rates were explained by differences in health insurance coverage and socioeconomic status.
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From page 429... ...
However, Hispanic children have more physician visits than black children, and working-age Hispanics have similar physician visit rates as their black counterparts. TABLE 10-8 Visit and Hospitalization Rates, by Age Category and National Origin Visit and Hospitalization Rates Had Mean Had Non- Mean Had Age and Physician Number Physician Number Inpatient National Origin Visit (%)
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From page 430... ...
The average numbers of annual visits were 2.8 and 2.4, respectively. Finally, we used multivariate logistic regression analysis to examine differences in the probability of having a physician visit, having a nonphysician visit, and having an inpatient stay between working-age Hispanics and non-Hispanic whites by national origin, by nativity, and by language preference, controlling for age, sex, income, education, marital status, health insurance coverage, and health status (measured using self-rated general health and chronic conditions)
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From page 431... ...
By contrast, Hispanic children are slightly more likely than black children to incur medical expenditures, and their average expenditures are higher. Hispanic children and working-age adults also have much lower expenditures than whites for prescription drugs, whereas Hispanic children have higher prescription drug expenditures than black children.
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From page 432... ...
adults adults adults adults white adults black adults not Origin = 10-9 19962000 Origin Rican n.a. and Hispanics Children Working-age Seniors Children Working-age Seniors Children Working-age Seniors Children Working-age Seniors Children Working-age Seniors Children Working-age Seniors TABLE National Age National All Mexican Puerto Cuban Non-Hispanic Non-Hispanic NOTE: SOURCE:
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From page 433... ...
As in the preceding section, we used multivariate logistic regression analysis to assess differences in the probability of incurring medical expenditures and incurring prescription drug expenditures between working-age Hispanics and non-Hispanic whites by national origin, by nativity, and by language preference, controlling for other factors than can affect the use of health care. We found that, other things being equal, Hispanics in all national-origin groups are significantly less likely than whites to incur medical or prescription drug expenditures (P < .001)
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From page 434... ...
For example, studies have found that satisfaction is associated with health care utilization, patient compliance with provider recommendations, and willingness to initiate malpractice litigation (Sherbourne, Hays, Ordway, DiMatteo, and Kravitz, 1992; Vaccarino, 1977; Zastowny, Roghmann, and Cafferata, 1989)
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From page 435... ...
found no differences in global ratings of care between Hispanic and white adults enrolled in 53 commercial and 31 Medicaid managed care plans across the United States. Not surprisingly, language seems to matter enormously in Hispanics' reports of their experiences with health care as well as in their global ratings
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From page 436... ...
Hispanics who spoke Spanish reported worse experiences than whites with regard to timeliness of care, provider communication, staff helpfulness, and health plan service, whereas Hispanics who spoke English reported experiences similar to those of whites. In striking contrast to their reports of care, however, Hispanics who spoke Spanish gave higher global ratings to their physicians and to their health plans than both whites and English-speaking Hispanics.
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From page 437... ...
The finding in several studies that Spanish-speaking Hispanics give higher global ratings than English speakers to their physicians and health plans despite reporting worse care experiences is counterintuitive. Researchers have suggested that reports of care experiences are less subjective than global ratings, and that the high global ratings given by Spanish speakers reflect their low expectations regarding their interactions with the health care system (e.g., Weech-Maldonado et al., 2001)
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From page 438... ...
Unsurprisingly, Hispanics have lower rates of use of prenatal care and preventive services than whites, although for certain of these services the gap between Hispanics and whites has narrowed in recent years. Hispanic children and working-age adults also have fewer physician visits than their white counterparts, and Hispanics of all ages have fewer visits to nonphysician providers than whites.
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From page 439... ...
. Thus, compared with Mexicans, Puerto Ricans and Cubans are more likely to have health insurance coverage and a usual source of health care, have more physician visits, and have higher expenditures for medical care.
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From page 440... ...
The apparent success of Medicaid eligibility expansions in increasing low-income women's use of prenatal care and of the Vaccines for Children program in reducing disparities in childhood vaccination rates demonstrates the potential of public programs and publicprivate partnerships to enhance uninsured people's access to essential health care services. However, further large-scale expansions of federally subsidized programs, such as Medicaid and SCHIP, seem unlikely in this age of welfare reform and federal budget deficits.
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From page 441... ...
Finally, the growth and geographic dispersion of the Hispanic population will challenge health care delivery systems and providers unaccustomed to caring for diverse groups of patients. In recent years, the concept of cultural competence has been proposed as a key factor in reducing racial and ethnic disparities in access to and quality of health care.
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From page 442... ...
. Access to prenatal care following major Medicaid eligibility expansions.
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From page 443... ...
. Racial and ethnic differences in access to medical care in managed care plans.
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From page 444... ...
. Entry into prenatal care -- United States, 19891997.
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From page 445... ...
. Language acculturation and screening practices of elderly Hispanic women: The role of exposure to health-related information from the media.
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From page 446... ...
. Hispanic health care disparities: Challenging the myth of a monolithic Hispanic population.
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