Barriers to Health Care for Hispanics in the US
While according to the US Census Bureau one in six persons living in the US is of Hispanic origin, they account for one-third of the country’s uninsured. Many factors may contribute to this statistic, including poverty, transportation, immigration status, and language barriers and can affect access and quality of care.
Contributing Factors:
1. Poverty
A significant factor which contributes to a lack of proper health care is poverty. Using the new Supplemental Poverty Measure, the 2010 census found that 28.2% of the 50.5 million Hispanics in the US live in poverty (2, 3). Many Hispanics have low-paying jobs which do not provide health benefits to their employees. In addition, many hold multiple jobs and cannot take time off of work to go to the doctor. Also, many low income families live in areas lacking health clinics and do not have transportation to doctor’s offices which are often far from their homes. All of these factors make it difficult for those living in poverty to access proper health care.
2. Concerns regarding immigration status
While poverty affects access to health care, the Hispanic population is 50% more likely to be uninsured when compared with the African American population, whose median income is slightly lower than that of the Hispanic population. This may result from concern regarding immigration status. According to the Pew Hispanic Center, 76% of undocumented immigrants are from Latin America, and illegal immigrants are unable to obtain medical coverage from government programs. In addition, legal immigrants face barriers to health care. Immigrants must live in the US for five years before they can be enrolled in Medicaid, and many are afraid to do so for fear that using government aid may affect their immigration status or ability to obtain citizenship.
3. Language Barriers
In a study sponsored by The Commonwealth Fund, which evaluated health care quality for minorities, Hispanics reported the greatest difficulty in communication with physicians of all ethnic groups. In fact, 33% reported problems in communication, compared with 16% of whites (4). This is due to several factors, especially language barriers. While interpreters should be provided to patients, only 48% of those requiring an interpreter reported usually having one, and only 1% reported having a trained interpreter (4).
4. Cultural Differences
Cultural differences, apart from language, can also affect quality of health care. In fact, even Hispanic Americans whose primary language is English are less satisfied with patient-physician communication. This dissatisfaction is likely due to cultural differences. In general, Hispanics tend to value the family unit, and they may involve family members in treatment processes (5). Trying to include the family members may improve the patient’s adherence to a treatment plan. Inclusion of the family has been used in studies researching culturally competent intervention programs, and this allocentric aspect, in conjunction with other factors, was found to improve health (6, 7). In addition, in Hispanic culture, it is considered rude to disagree with the health care provider (5). Even in the US, about 1/3 of Hispanics report failing to follow the doctor’s advice because they disagreed with it (4). Understanding these cultural differences can help improve patient compliance with treatment and improve health outcomes.
1. Poverty
A significant factor which contributes to a lack of proper health care is poverty. Using the new Supplemental Poverty Measure, the 2010 census found that 28.2% of the 50.5 million Hispanics in the US live in poverty (2, 3). Many Hispanics have low-paying jobs which do not provide health benefits to their employees. In addition, many hold multiple jobs and cannot take time off of work to go to the doctor. Also, many low income families live in areas lacking health clinics and do not have transportation to doctor’s offices which are often far from their homes. All of these factors make it difficult for those living in poverty to access proper health care.
2. Concerns regarding immigration status
While poverty affects access to health care, the Hispanic population is 50% more likely to be uninsured when compared with the African American population, whose median income is slightly lower than that of the Hispanic population. This may result from concern regarding immigration status. According to the Pew Hispanic Center, 76% of undocumented immigrants are from Latin America, and illegal immigrants are unable to obtain medical coverage from government programs. In addition, legal immigrants face barriers to health care. Immigrants must live in the US for five years before they can be enrolled in Medicaid, and many are afraid to do so for fear that using government aid may affect their immigration status or ability to obtain citizenship.
3. Language Barriers
In a study sponsored by The Commonwealth Fund, which evaluated health care quality for minorities, Hispanics reported the greatest difficulty in communication with physicians of all ethnic groups. In fact, 33% reported problems in communication, compared with 16% of whites (4). This is due to several factors, especially language barriers. While interpreters should be provided to patients, only 48% of those requiring an interpreter reported usually having one, and only 1% reported having a trained interpreter (4).
4. Cultural Differences
Cultural differences, apart from language, can also affect quality of health care. In fact, even Hispanic Americans whose primary language is English are less satisfied with patient-physician communication. This dissatisfaction is likely due to cultural differences. In general, Hispanics tend to value the family unit, and they may involve family members in treatment processes (5). Trying to include the family members may improve the patient’s adherence to a treatment plan. Inclusion of the family has been used in studies researching culturally competent intervention programs, and this allocentric aspect, in conjunction with other factors, was found to improve health (6, 7). In addition, in Hispanic culture, it is considered rude to disagree with the health care provider (5). Even in the US, about 1/3 of Hispanics report failing to follow the doctor’s advice because they disagreed with it (4). Understanding these cultural differences can help improve patient compliance with treatment and improve health outcomes.
Source:
1. Feder, J. Lester. "Barriers to Health Care for Hispanics." The Daily Beast. The Newsweek, 07 June 2010. Web. 31 Jan. 2012. <http://www.thedailybeast.com/newsweek/2010/06/07/falling-through-the-cracks.html>.
2. Lopez, Mark Hugo, and D'Vera Cohn. "Hispanic Poverty Rate Highest In New Supplemental Census Measure." Pew Hispanic Center. Pew Hispanic Center,
11 Nov. 2011. Web. 02 Apr. 2012.
3. United States. US Census Bureau. The Hispanic Population 2010: 2010 Census Briefs. By Sharon R. Ennis, Merarys Ríos-Vargas, and Nora G. Albert. US
Census Bureau, May 2011. Web. 2 Apr. 2012.
4. Collins, Karen S., Dora L. Hughes, Michelle M. Doty, Brett L. Ives, Jennifer N. Edwards, and Katie Tenney. Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans. Rep. The Commonwealth Fund, Mar. 2002. Web. 27 Mar. 2012.
5. National Alliance for Hispanic Health. "Getting to Know the Culture." Quality Health Services for Hispanics: The Cultural Competency Component. Ed. Deborah Guadalupe Duran, Guadalupe Pacheco, and Leonard G. Epstein. 2001. 27-38.
6. La Roche, Martin J., Daphne Koinis-Mitchell, and Leyla Gualdron. "A Culturally Competent Asthma Management Intervention: A Randomized Controlled Pilot Study." Annals of Allergy, Asthma & Immunology 96.1 (2006): 80-85. Print.
7. Brown, S. A., A. A. Garcia, K. Kouzekanani, and C. L. Hanis. "Culturally Competent Diabetes Self-Management Education for Mexican Americans: The Starr County Border Health Initiative." Diabetes Care 25.2 (2002): 259-68. Diabetes Journals. American Diabetes Association. Web. 26 Mar. 2012.
1. Feder, J. Lester. "Barriers to Health Care for Hispanics." The Daily Beast. The Newsweek, 07 June 2010. Web. 31 Jan. 2012. <http://www.thedailybeast.com/newsweek/2010/06/07/falling-through-the-cracks.html>.
2. Lopez, Mark Hugo, and D'Vera Cohn. "Hispanic Poverty Rate Highest In New Supplemental Census Measure." Pew Hispanic Center. Pew Hispanic Center,
11 Nov. 2011. Web. 02 Apr. 2012.
3. United States. US Census Bureau. The Hispanic Population 2010: 2010 Census Briefs. By Sharon R. Ennis, Merarys Ríos-Vargas, and Nora G. Albert. US
Census Bureau, May 2011. Web. 2 Apr. 2012.
4. Collins, Karen S., Dora L. Hughes, Michelle M. Doty, Brett L. Ives, Jennifer N. Edwards, and Katie Tenney. Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans. Rep. The Commonwealth Fund, Mar. 2002. Web. 27 Mar. 2012.
5. National Alliance for Hispanic Health. "Getting to Know the Culture." Quality Health Services for Hispanics: The Cultural Competency Component. Ed. Deborah Guadalupe Duran, Guadalupe Pacheco, and Leonard G. Epstein. 2001. 27-38.
6. La Roche, Martin J., Daphne Koinis-Mitchell, and Leyla Gualdron. "A Culturally Competent Asthma Management Intervention: A Randomized Controlled Pilot Study." Annals of Allergy, Asthma & Immunology 96.1 (2006): 80-85. Print.
7. Brown, S. A., A. A. Garcia, K. Kouzekanani, and C. L. Hanis. "Culturally Competent Diabetes Self-Management Education for Mexican Americans: The Starr County Border Health Initiative." Diabetes Care 25.2 (2002): 259-68. Diabetes Journals. American Diabetes Association. Web. 26 Mar. 2012.