Studies look at Hispanics' access to U.S. health care system

Sep 22 2008

Three studies published online on Wednesday in the American Journal of Public Health look at how poverty, language and health insurance coverage affect access to care among foreign-born U.S. residents, particularly Hispanics, HealthDay/U.S. News & World Report reports.

In the first study, C. Annette DuBard of University of North Carolina's Cecil G. Sheps Center for Health Services Research and colleague Ziya Gizlice of UNC's Center for Health Promotion and Disease Prevention examined Behavioral Risk Factor Surveillance System data from 2003 to 2005 on 45,076 U.S. Hispanic adults. DuBard and Gizlice found that more than half of Spanish-speaking adults were uninsured and did not have a primary care physician, and one out of four had to forgo needed medical care within the last 12 months because they could not afford it.

Researchers also compared Spanish-speaking Hispanics with those who spoke English for 25 health indicators and found that those in the Spanish-speaking group had significantly lower rates of chronic disease, obesity and smoking. They also were less likely than English-speaking Hispanics to use preventive health care services and participate in a physical activity. DuBard said, "We found that the U.S. Spanish-speaking adult population represents a particularly vulnerable subset of U.S. Hispanics, with far worse access to the health care system." She added, "Fully addressing health care disparities will require a better understanding of contributing factors within the rich diversity of the U.S. population."

According to Rea Panares, director of Minority Health Initiatives, more than 70% of Spanish-speaking Hispanics are uninsured, particularly in areas experiencing new growth. She said the problem in part can be attributed to a federal policy to not reimburse states for care provided to documented immigrants who have not lived in the U.S. long enough to qualify for benefits.

William Vega, a professor of family medicine at the University of California-Los Angeles David Geffen School of Medicine, said that poverty and not language is the cause of limited access to health care among Hispanics.

He added, "Spanish language is a proxy of low acculturation, lower income and lower education in the [Hispanic] population, and studies have shown that this language differential does not persist across generations, that is, the children of immigrants become English-language dominant in childhood even when Spanish is their first language."

Additional Research

Another AJPH study conducted by researchers from the Children's Hospital of Philadelphia found that after the year 2000, foreign-born children were 1.59 times more likely than U.S.-born children to be uninsured. The study also found that indigent foreign-born children were just as likely as U.S.-born children to have public insurance coverage.

In addition, an AJPH study conducted by researchers from the University of Texas found that the number of uninsured residents increased by 7% from 2000 to 2005 along the U.S.-Mexican border, indicating that "existing disparities in health care access will continue to undermine the health status of the region's population unless major health care policy reforms are initiated to promote greater accessibility to U.S. health care" (Reinberg, HealthDay/U.S. News & World Report, 9/17).

An abstract of the DuBard/Gizlice study is available online. An abstract of the Children's Hospital of Philadelphia study is available online. The University of Texas study abstract also is available online.