The Primary Care Experience of Hispanic Children: Current Disparities and Trends in Access to and Quality of Care

1. The Primary Care Experience of Hispanic Children: Current Disparities and Trends in Access to and Quality of Care William Freeman, MPH Health Scientist Administrator NHQR/DR Production Team

2. Presenter Disclosures: No Relationships to Disclose - No personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months

3. Data Sources • Principal Data Source: AHRQ’s Medical Expenditure Panel Survey (MEPS); data years 2003-2007 • Secondary Sources: NCHS’s National Health Interview Survey (NHIS) and National Immunization Survey (NIS)

4. Methodology: Quality Measures Included in Analysis • Access to the healthcare system (3) (i.e. reported insurance status) • Usual source of primary care (3) • Utilization of preventive & common services (5) • Receipt of patient-centered (4-measure composite) (1) • Receipt of timely of routine care (2)

5. Methodology Notes • Comparison between Hispanic children (all races) and non-Hispanic White children (following NHQR/DR methods). • 2-part disparities test: test of significance and 10% difference. • Trending utilized gap analysis and change over time. • Multi-stratified analyses, where possible.

6. Results Summary • Access: Hispanic children – 13.2% uninsured; non-Hisp. White – 7%. Gap remained the same from 2002-2007. • Usual Primary Care Provider: Gap closed. Hispanic Children – improved 1% per year, but remained the same for non-Hispanic White. • Office Visits within the Past Year: Rates did not change significantly for either group, gap remained 10-12% over period.

7. Access to the HC System • Cost Burden* (>10%) • Uninsured All Year Source: MEPS Source: MEPS

8. Usual Sources of Care • Usual Source of • Care for Those • in Poor Health • Usual Primary Care Provider Source: NCHS, National Health Interview Survey Source: MEPS

9. Preventive Services • Dental Visit within Past Year: In 2007, Hispanic children only 37.1% compared to 52.8% for non-Hispanic Whites Source: MEPS

10. Preventive Services • Receipt of All Recommended Vaccinations*: Source: NCHS, National Immunization Survey

11. Patient-Centered Care • Composite: 1. sometimes or never listening carefully 2. explaining things clearly 3. respecting what they had to say 4. spending enough time with them • Gap decreased such that with the most recent year there was no statistically significant difference. Source: MEPS

12. Timeliness • Children who had an appointment for routine health care in the last 12 months who got appointments for routine care as soon as wanted • Gap decreased ~ 40%, but when match insurance status gap decreased ~ 60% PUBLIC INSURANCE ONLY Source: MEPS

13. Recommendations to Advance Hispanic Children’s Health • Increase focus of available resources on access to the system (attainment of insurance), and receiving primary care preventive services, where gaps are stagnant when compared to non-Hispanic Whites • Once insured, most Hispanic children were able to attain a usual source of care, and receive care that was patient-centered comparable to non-Hispanic Whites