In practice, many researchers on the quality of health care agree that hispani measurement of technical quality should depend much more on process data than on health outcomes Brook et al.
Puerto Ricans are again the exception, as their indicators of health care access do not differ by language preference. The data summarized in this chapter raise a of critical issues for public and private policy makers concerned about the well being of Hispanics in the United States, for health care providers, and for the health care system more generally. Using the Medical Expenditure Panel Survey MEPSMonheit and Vistnes found that 42 percent of non-elderly Hispanics had employer-provided insurance, compared with 71 hispanlc of nonelderly whites.
In fact, English speakers eseking to have care experiences that are very similar to those of non-Hispanic whites.
Moreover, only 76 percent of Hispanic males who were offered insurance took it up, compared with 85 percent of white males. The Center has initiated a task force of legal service providers in the community to identify and meet unmet legal needs of low and moderate income persons. This is irfine the case for immigrants who are not naturalized citizens.
The important role of interpreters in improving Hispanics' experiences with health care is noteworthy.
Uncertainty about Medicaid and SCHIP eligibility and the risks of enrolling in Medicaid were added to other long-standing barriers to participation in public health insurance programs, such as lack of information and language. Hiepanic contrast, Morales and colleagues 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.
Most uninsured participants in the focus groups admitted not asking about health insurance when they applied for their jobs and reported that health insurance takes a back seat to basic needs sseeking as food and rent. Only 58 percent of Hispanic smokers receive smoking cessation counseling, compared with 82 percent of white smokers.
This explanation is consistent with the particularly high global ratings given to physicians by Spanish speakers. This may be especially true for low-income Medicaid recipients and for recent immigrants whose prior experiences in their countries of origin are likely successfu have been in health care systems that provide markedly inferior care to the less privileged.
Lacking health insurance makes the costs of health care services prohibitive for many people and is the most important barrier to adequate health care access. In addition, Hispanics' low incomes and occupational characteristics are associated with low rates of health insurance coverage. Nearly one-half of foreign-born, working-age Hispanic adults are uninsured, compared with 27 percent of working-age Hispanic adults born in the United States.
Not surprisingly, the provision of information and services in patients' preferred language, including patient access to qualified, professional interpreters, assumes a central role in several of the standards U. In a recent survey Doty, bnearly half of Spanish speakers reported problems communicating with or understanding their physician. 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.
The assistance includes teaching persons with very little formal education and training to successfully represent themselves in court.
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Notably, the uninsured rate does not vary by nativity for Hispanics of Puerto Rican origin, a pattern that differs from that of the other national-origin groups and probably reflects the unique circumstances of Puerto Ricans regarding U. The finding in several studies that Spanish-speaking Hispanics give higher global ratings than Succdssful speakers to their physicians and health plans despite reporting worse care experiences is counterintuitive.
The low of Hispanic physicians also exacerbates the effects on whtt of geographic physician shortages. This may be a manifestation of Spanish speakers' low expectations of the health care delivery system, or it may reflect a cultural disposition to be deferential to health care professionals. 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.
Medical Care. Thus, 48 percent of foreign-born Hispanics have a physician visit during the year, compared with 57 percent of the U.
In a recent study, Marquis et al. Similarly, most of the studies of interpreters have used data from individual institutions and consequently may not be generalizable.
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In a study of patients treated in medical group practices, Morales et al. Once answered, the visitor is notified by and provided a link to the answer.
In particular, working-age adults of Puerto Rican origin have much higher average total expenditures and expenditures for prescription drugs than Mexicans do. Differences in rates of employer-provided coverage have been documented by national origin, nativity, length of residence in the United States, and language Schur and Feldman, Several recent studies have compared process quality of care for Hispanic and white Medicare beneficiaries jrvine in Medicare managed care plans e.
Expenditures for noncitizens, on average, are less than half as large as expenditures for naturalized citizens. Limited proficiency in English affects Hispanics' ability to seek and obtain health care hospanic reduces access to health information in the media Ruiz, Marks, and Richardson, An intriguing finding of the research to date is that Spanish-speaking Hispanics give higher global ratings to their physicians and health plans than whites do, hispxnic reporting worse experiences.
Hispahic example, Baker, Hayes, and Fortier studied Hispanic adults seen in a public hospital emergency department. Although most of this research pertains to blacks, studies based on patient reports suggest that these provider attitudes and behaviors may influence the care that Hispanics receive as well. Legal Grind provides people with a relaxed atmosphere as they discuss their legal issues with lawyers.
Infor example, 23 percent of Hispanics lived in poverty, compared with 8 percent of non-Hispanic whites, and 56 percent of Hispanic adults seeikng 25 or older had a high school diploma, compared with 88 percent of non-Hispanic white hispanlc. Notably, Monheit and Vistnes found little effect of industry and occupation on employer-provided insurance in their multivariate analyses, although firm size remained an important factor.
More information is available regarding Hispanics' experiences and satisfaction with care.
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More recent studies, however, have found differences in both experiences of care and satisfaction by race and ethnicity. Taken together, the findings summarized successfjl the preceding paragraphs confirm the primacy of language in patients' experiences with health care.
Recent arrivals to the United States are more likely to be isolated from mainstream U. Rates of being uninsured vary across Hispanic subgroups defined by national origin; for instance, Mexicans and Central and South Americans have higher uninsured rates than Puerto Ricans or Cubans Carrasquillo, Orav, Brennan, and Burstin, ; Hoffman and Pohl, Lack of health insurance coverage may make prenatal care unaffordable for many Hispanic women. Hkspanic, 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.
The latter patients, in turn, gave higher ratings than patients who communicated directly with the provider but said an interpreter should have been called.
Health care use among undocumented Latino immigrants. New York: Commonwealth Fund; Oct, Furthermore, among the foreign-born the uninsured rate is much higher for those who have been in the United States less than five years and for noncitizens than for those who have been in the United States longer than five years and for naturalized citizens, respectively.