Access to health care for Hispanics

Article Abstract:

The January 9, 1991 issue of The Journal of the American Medical Association is devoted to the health of, and health care for, Hispanics in the US. In this article, the factors that affect access to medical care for these 20 million people are discussed. More than 70 percent of the Hispanic population in the US live in six states (California, Texas, New York, Florida, New Jersey, Illinois); Hispanic subgroups include Mexican Americans (62 percent), Puerto Ricans (13 percent), Central and South Americans (12 percent), Cubans (5 percent), and others (8 percent). Most live in inner cities, near hospitals and clinics. This review considers access to care as affected by socioeconomic status; demographic and epidemiological factors that predict health care needs; locational and institutional factors that can limit access to care; the lack of Hispanic health care professionals; and the implications of proposals under consideration that could improve access. Hispanics have generally completed fewer years of school than whites, and have lower incomes: the median 1988 Hispanic family income was $21,800, compared with a median white family income of $33,900. Disease patterns within the main Hispanic subgroups are briefly discussed. Hispanics living near the Mexican-US border face special problems of high accident rates, poor living conditions (in unincorporated colonias), and overcrowding of patients who use the health care system in Texas. The only health care proposal that can be enacted soon is one that would extend Medicaid coverage to more women and children, but the nation's governors have tried to slow its enactment. Other proposals include a national health insurance, mandatory provision of health insurance by employers, reduction in costs of private insurance, and state support for providers (hospitals, clinics) of unreimbursed (charity) care. These are evaluated; none is close to being passed into law. Hispanics, like all US residents, need health coverage. They face special problems because of low educational, job skill, and income levels. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Hispanic health: time for data, time for action

Article Abstract:

The January 9, 1991 issue of The Journal of the American Medical Association is devoted to issues relevant to the health and health care of Hispanics in the US, a group that will constitute the largest minority group in the country by the early part of the next century if present trends continue. A recurrent theme among the articles in the Journal issue is the heterogeneity of the Hispanic population; in modern usage, the different historical and geographic backgrounds of Spanish-speaking peoples are reflected in awareness of them as Mexican Americans, Puerto Ricans, Central or South Americans, or Cuban Americans. Several topics are touched on briefly in this article highlighting the Journal reports. Hispanics suffer an increased prevalence (compared with non-Hispanic whites) of diabetes (and greater disease severity), high blood pressure, lead poisoning, measles, injuries, and violent death (the latter four are particularly high in Hispanic children). They have limited access to health services, and are more likely to be uninsured. AIDS affects a disproportionately large number of Hispanics (almost 40 percent of those under 13 in New York City), a problem that must be addressed. Hispanic women and children do not receive adequate health care. One article addresses the problems in US-Mexican border communities, emphasizing the need for establishing health and sanitation systems. Research should aim at the needs of the Hispanic communities, but should not neglect the strengths of this population; neonatal mortality is quite low, as is the proportion of low-birthweight babies. Two articles address the complexity and heterogeneity of the population. This large, vital group demands recognition from, and access to, the US health care system. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Beyond universal health insurance to effective health care

Article Abstract:

Although many reforms of the health care system have been enacted since World War II, including services for veterans through the Veterans Affairs Department, and Medicaid and Medicare, the health care delivery system drastically needs to be reorganized. Universal health insurance is not the complete solution, as the experience in New York City, which effectively provides universal coverage, makes clear. There are numerous nonfinancial barriers to access to health care, including cultural, demographic, geographic, and institutional factors. Most physicians prefer not to treat the poor or minorities, and they do not practice in rural areas. Universal coverage would not change this. Nor would it change the pattern of inner-city residents using the emergency department, clinics and inpatient hospital services for primary care. In addition, language barriers and illegal citizenship status keep some immigrants from using the health care system. Because of these and other obstacles, the goal of universal health insurance falls short even if it could be funded. The objective should be effective health care through expansion of Medicaid, subsidized coverage for the near-poor, private sector catastrophic insurance policies, state subsidies for uncompensated care (through ''sin'' taxes, or taxes on insurance premiums or hospital revenues), and expansion of the Federal Community Health Center Program, the National Health Service Corps, and state educational debt forgiveness programs. Because early action on national health insurance is unlikely, perhaps lowering the barriers that exist to the utilization of current programs and the expansion of others is a realizable interim alternative. (Consumer Summary produced by Reliance Medical Information, Inc.)

Planning, Economic aspects, Statistics, Health insurance, Medical care, Cost of, Health care costs, National health insurance

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