Special Issue of Medical Journal Explores Latino Health and Health Care

Hispanics and Health Care in the United States: Access, Information and Knowledge

More than one-fourth of Hispanic adults in the United States lack a usual health care provider, and a similar proportion report obtaining no health care information from medical personnel in the past year. At the same time, more than eight in 10 report receiving health information from alternative sources, such as television and radio, according to a Pew Hispanic Center (PHC) survey of Latino adults, conducted in conjunction with the Robert Wood Johnson Foundation (RWJF).

Heterogeneity in Health Insurance Coverage Among US Latino Adults

US Latinos of Mexican ancestry consis- tently had lower rates of health insurance coverage than did US non-Mexican Latinos. Approximately 65% of these disparities can be attributed to differ- ences in observed characteristics of the Mexican ancestry population in the US (e.g., age, sex, income, employment status, education, citizenship, language and health condition). The remaining disparities may be attributed to unobserved heterogeneity that may include unobserved employment-related information (e.g., type of employment and firm size) and behav- ioral and idiosyncratic factors (e.g., risk aversion and cultural differences).

This study confirmed that Latinos of Mexican ancestry were less likely to have health insurance than were non-Mexican Latinos. Moreover, while differences in observed socioeconomic and demo- graphic factors accounted for most of these disparities, the share of unobserved heterogeneity accounted for 35% of these differences.

Perceived Quality of Care, Receipt of Preventive Care, and Usual Source of Health Care Among Undocumented and Other Latinos

Undocumented Latinos had the lowest percentages of insurance coverage (37% vs 77% US- born, P < 0.001), usual source of care (58% vs 79% US- born, P < 0.001), blood pressure checked (67% vs 87% US-born, P < 0.001), cholesterol checked (56% vs 83% US-born, P < 0.001), and reported excellent/good care in the past year (76% vs 80% US-born, P < 0.05). Undocumented Latinos also reported the highest percentage receiving no health/health-care information from their doctor (40% vs 20% US-born, P < 0.001) in the past year. Adjusted results showed that undocumented status was associated with lower likelihood of blood pressure checked in the previous 2 years (OR = 0.60; 95% CI, 0.43– 0.84), cholesterol checked in the past 5 years (OR = 0.62; 95% CI, 0.39–0.99), and perceived receipt of excellent/ good care in the past year (OR = 0.56; 95% CI, 0.39–0.77). Having a usual source of care increased the likelihood of a blood pressure check in the past 2 years and a cholesterol check in the past 5 years.

Effects of Health Insurance on Perceived Quality of Care Among Latinos in the United States

Insurance availability had an odds ratio of 1.47 (95% CI, 1.22–1.76) net of confounders in predict- ing perceived quality of care among Latinos. The largest gap in rates of excellent/good ratings occurred among the insured with eight or more doctor visits compared to the uninsured (76.2% vs. 54.6%, P<.05).

Future research can gain additional insights by examining the impact of health insurance on processes of care with a refined focus on specific transactions between consumers and providers’ sup- port staff and physicians guided by the principles of patient-centered care.

Perceived Discrimination and Self-Reported Quality of Care Among Latinos in the United States

US-born Latinos were twice as likely to report general discrimination as foreign born: 0.32 SD versus −0.23 SD (P < 0.001) on the Detroit Area Survey (DAS) discrimination scale. Higher DAS discrimination was associated with lower self-reported quality of care in US-born Latinos [OR = 0.5; 95% CI (0.3, 0.9); P = 0.009]. For foreign-born Latinos, report of any doctor or medical staff discrimination was associated with lower quality of care [OR = 0.5; 95% CI (0.3, 0.9); P = 0.03], but the DAS was not. For US-born Latinos, doctor discrimination and higher DAS were jointly associated with worse doctor-patient communication. For foreign-born Latinos, the effect of discrimination on doctor-patient communication was significantly smaller than that observed in US-born Latinos.

Given the association between per- ceived discrimination and quality of care, strategies to address discrimination in health-care settings may lead to improved patient satisfaction with care and possibly to improved treatment outcomes.

Diabetes Awareness and Knowledge Among Latinos: Does a Usual Source of Healthcare Matter?

Significant differences in USHC between Latino groups were found with Mexican Americans having the lowest rates (59.7%). USHC was associated with significantly higher diabetes awareness and knowledge (OR=1.24; 95%CI=1.05-1.46) after account- ing for important healthcare access factors. Men were significantly (OR=0.64; 95%CI=0.52-0.75) less informed about diabetes than women.

We found important and previously unreported differences between Latinos with a current USHC provider, where the predominant group, Mexican Americans, are the least likely to have access to a USHC. USHC was associated with Latinos being better informed about diabetes; however, socioeconomic bar- riers limit the availability of this potentially valuable tool for reducing the risks and burden of diabetes, which is a major public health problem facing Latinos.

The Role of Spirituality Healing with Perceptions of the Medical Encounter among Latinos

Six percent of individuals reported that they had ever consulted a curandero, 60% prayed for healing, 49% asked others to pray for healing, and 69% considered spiritual healing as very important. In multivariable analyses, feeling confused was associated with increased odds of consulting a curandero (OR=1.58; 95% CI, 1.02– 2.45), praying for healing (OR=1.30; 95% CI, 1.03–1.64), asking others to pray for healing (OR=1.29; 95% CI, 1.03– 1.62), and considering spiritual healing as very important (OR=1.30; 95% CI, 1.01–1.66). Feeling frustrated by a lack of information was associated with asking others to pray for healing (OR=1.29; 95% CI, 1.04–1.60). A better perception of quality of medical care was associated with lower odds of consulting a curandero (OR=0.83; 95% CI, 0.70–0.98).

Confronting Inequities in Latino Health Care

The goal of this supplement is to present new information about the quality of health care among US Latino groups and focuses on the Latino patient’s perspective. Consistent with recommendations of the Institute of Medicine’s Crossing the Quality Chasm report1 and that of others2–4, this issue emphasizes patient-centeredness as a core component of a health care system designed to improve quality of care. Patient- centeredness is defined as providing care that is respectful of and responsive to individual preferences, needs, and values, while ensuring that patient preferences inform clinical deci- sions. This presumes that clinicians do a good job of assessing patient needs, expectations and environment, using information from patients about their family, cultural background, health and health care behaviors, primary language, health care literacy and other factors to improve and create new services.