Access and Utilization

Primary and Acute Care

Health Insurance and Other Barriers: Hispanic elders living in the United States are underinsured and more likely to be living in poverty. Although Hispanic/Latino elders 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 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).

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 elders (For a more complete discussion, see Villa, et al., 1993).