Primary and Acute Care

Health Insurance and Other Barriers

Hispanic older adults living in the United States are underinsured and more likely to be living in poverty. As of 2019, the uninsured rate among Latinos was 20% vs 8% among NHW (office of health policy 2021). Although Hispanic/Latino older adults are more likely to have health insurance than their younger family members because of the availability of Medicare and Medicaid, the percentage of non-institutionalized Hispanics aged 65-84 with no insurance (3%) is higher than among similar NH whites or NH blacks (Kramerow et al, 1999). Older Hispanics also have the highest percentage with Medicare/Medicaid insurance, almost half in the 85 and over population. Health care is hindered in this population by lower access to health services and less use of preventive services. Barriers to access are primarily socioeconomic, but acculturation exerts an effect through its association with language skills, education, and employment.

Differences in access to care were compared from NIHS data, 2019-2023 (Ayodele et al., 2025). Foreign-born Hispanics experienced the highest uninsured rate at about 26% vs US born non-Hispanics at about 4%. In 2023, the uninsured rates among Hispanic older adults, 65+ were 5.2 %, which was significantly higher as compared to other groups (Non-Hispanic White older adults, uninsured 0.2%).

Hispanics continue to experience challenges in healthcare access and often delay care due to cost. Despite after controlling for income and education being Hispanic and foreign-born were associated with higher likelihood of being uninsured (Ayodele et al., 2025). This helps inform that the uninsured gap goes beyond poverty and education. The article makes emphasis to provider supply, language and institutional fear (reluctance to engage with system).

Differences in access to care and use of health services over the last two decades were compared in Hispanics and non-Hispanic whites of all ages (Weinick, et al., 2000). Using data from three nationally representative medical expenditure surveys and multivariate analyses to adjust for disparities in health insurance and income, there was observed an increasing disparity between the two ethnicities between 1977 and 1996. Even after adjustments for income and health insurance coverage in 1996, one half to three quarters of the ethnic disparity remained.

Primary Care, Hospitalization, and Procedures

One approach to comparing access to primary care is to quantify hospitalizations for preventable conditions as an indicator of limited access to primary care. Using discharge data from 10 states, a study out of Georgetown University found that, even after controlling for differences in patient’s health care needs, socioeconomic status, insurance coverage, and availability of primary care, Hispanics were at greater risk of hospitalization for preventable diseases than were NHW (Gaskin, Hoffman, 2000).

Hispanic patients experienced higher barriers or challenges to outpatient care access in which included socioeconomic status, uninsured, cost and limited provider availability (Feng et al., 2018). [AM1]

Age-adjusted rates of percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG) were compared in Mexican-Americans and NHWs hospitalized in Texas for coronary heart disease (Ramsey, et al., 1997). Men were more likely than women to receive either procedure (33 vs. 22%, p <.01), and NHW were more likely to receive PTCA than MA (23 vs. 13%, p<.01), but not CABG. After adjustments for extent of disease and other potential confounders, marginal differences in receipt of PTCA, but not CABG, remained between the two ethnicities, suggesting a bias in the delivery in this type of health care service.

When utilization of primary care is focused on only older Hispanics, the results are less clear. Some studies find higher number of physician visits for older Hispanics compared to other ethnic populations. It is possible, however, that these reports reflect poorer health status of older Hispanic/Latino older adults (For a more complete discussion, see Villa, et al., 1993).