Health Care Access for Latino Patients

1. Health Care Access for Latino Patients Olveen Carrasquillo, MD, MPH Director, Columbia Center for the Health of Urban Minorities

3. Outline • Variable Specification • Latino Health Paradox • Latino Uninsured • “The Solution” • CHUM Access to Care Research • CHUM Advocacy

4. Variable Specification: WHAT IS A Hispanic / LATINO????

5. The Big 3 Mexicans 59% Puerto Ricans 9.6% Cubans 3.5% Newer groups Dominicans 2.2% Salvadoreans 1.9% Columbians 1.3% Hispanic Population in the US: 32 million in 2000, 41 million in 2004 ???Spaniards 5%

6. Latinos in New York City • 2.2 Million (27% of NYC pop) • Bronx 48% Latinos (650,000) • 49% PR, 21% Dom • Manhattan 27% Latinos (420,000) • 29% PR, 32% Dom • Brooklyn 20% Latinos (490,000) • 44% PR, 14% Dom, 12% Mex • Queens 25% Latinos (555,000) • 20% PR, 13% DR, 11% Columbian, 10% Peruvian

8. Citizenship Status

9. What is Access to Care • What is it? • Does it Matter?

10. Dictionary: Access to Care • An individual's ability to obtain appropriate health care services. Barriers to access can be financial (insufficient monetary resources), geographic (distance to providers), organizational (lack of available providers) and sociological (e.g., discrimination, language barriers). • Efforts to improve access often focus on providing/ improving health coverage.

11. Anderson’s Behavioral Model of Access • Predisposing Factors: ethnicity, education income • Need for health care: health status, attitudes, perceptions • Enabling characteristics: health insurance, geography, # providers J Health Soc Behav 1995;36(1):1-10

12. Eisenberg Model of Access to Quality Health Care Source: Eisenberg J. JAMA 2000;284:2100-07

13. Bierman Model • Primary Access- barriers getting to system • insurance, cost, • Secondary Access- barriers within system • Appointments, hours, access to specialists • Tertiary Access- provider meeting patient needs • Language, culture, provider skills J Ambulatory Case Management 1998;21(3); 17-26

14. Inwood and Washington Heights compared to40 other NYC neighborhoods

15. Access to Care (table)

16. Access to Care • Many Inwood and Washington Heights residents have poor access to medical care: • about 20,000 people report no current health care coverage; • 34,000 people did not get needed medical care in the past year; • and 68,000 people do not have a personal doctor.

17. Factors That Influence Health Status

18. Health of Latinos

19. Diabetes Prevalence- diagnosed/undiagnosed • Even after adjust weight, SES, Hispanics 2-3 times more likely have DM Luchsinger J. “Diabetes” in Health Issues in the Latino Community, 2001

23. The Latino Paradox

26. Age Adjusted Death Rates

27. Latino paradox • Many studies link poverty to poor health • Latinos are poorer than African Americans but have lower overall mortality rates, death from cancer and heart disease, infant mortality than AAs/ whites • But--acculturation leads to poorer health outcomes

28. Latino paradox • What causes the paradox? Theories: • “Healthy immigrant”; “salmon” hypotheses • Strong social/family networks • Low tobacco and ETOH use especially in women • Religiosity • Traditional healing practices • Traditional diet • ? Lack of Health care

29. How US compares to DR WHO World Health Report ,2004

30. Health Care Access for Latino Patients Olveen Carrasquillo, MD, MPH Director, Columbia Center for the Health of Urban Minorities

31. Summary #1 • Despite the rest of my talk showing access barriers…. Latino’s overall health is not that bad

32. 45.8 MillionUninsured (15.7%)

33. New York City: 2003 NYC 21% Uninsured= 1.6 million 60% of uninsured in NYS live in NYC

34. Is Health Insurance Important?? • Of all the determinants of access to care insurance is by far most important !!!! • Less likely to have usual source of care • More likely to have unmet health care needs • More likely to rely on emergency room for care • Less likely to have preventive health services- Pap smears, mammograms, immunizations • Higher adjusted mortality rates • Higher preventable hospitalization rates

35. The IOM Disparities Report • Charge: Assess the extent of racial and ethnic differences in health care that are not otherwise attributable to known factors such as access to care (insurance /ability to pay) • This is somewhat artificial as many access- related factors affect the quality and intensity of health services. • These access-related factors are likely the most significant barriers to equitable care and must be addressed as an important first step to eliminating disparities

36. Source: US Bureau of the Census

37. Change in # Uninsured (1,000) Source: Harell & Carrasquillo JAMA 2003 289;9:1167

38. 1987 NHWS 58% Blacks 19% Hispanics 19% Asians 3% 2004 NHWS 48% Blacks 16% Hispanics 30% Asians 5% NHWs: No longer a majority of the uninsured:Trends in composition of uninsured population Source: Current Population Surveys

39. LATINO UNINSURED Source: Analysis of March 2002CPS Data

40. NYS: Insurance coverage by Hisp. Sub-group N= 925,000 650,000 300,000 800,000

41. Insurance DataCoverage by Immigrant Type # Uninsured 8.9 million 2.3 million 32.3 million Immigrants accounted for 26% of uninsured in US

42. Insurance Coverage among immigrants by length of time in US

43. Racial/ethnic disparities in insurance coverage by citizenship status

44. Insurance coverage among Hispanic sub-groups by citizenship status Source: March 2001CPS

46. New York City Source: Analysis of March 2003CPS Data

47. Health Coverage in NYC% of Uninsured Children in Immigrant Families Source: LANYC Immigrant Survey/ Urban Inst.

48. Health Coverage in NYC% of Uninsured Adults Source: LANYC Immigrant Survey/ Urban Inst.

49. Latino Advocacy • Primary Access- barriers getting to system • insurance, cost • Secondary Access- barriers within system • Appointments, hours, access to specialists • Tertiary Access- provider meeting patient needs • Language, culture, provider skills J Ambulatory Case Management 1998;21(3); 17-26

50. The Latino Uninsured:Failure of the Private Sector Source: Analysis of March 2002CPS Data