Much less information is available regarding the quality of health care for Hispanics than regarding access to care. An alternative explanation is that the high global ratings given to their physicians reflect a cultural disposition among Hispanics to be deferential to laino who are pd to be of higher status.
The average s of annual visits were 2. The jobs available to recent and undocumented immigrants who lack proficiency in English are unlikely to provide rsnt insurance as a benefit of employment. For Puerto Ricans, by contrast, language preference is unassociated with having a usual source of care, although Puerto Ricans who prefer English are more likely than those who prefer Spanish to have a physician's office as their usual source.
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Notably, the uninsured rate does not vary by nativity for Hispanics of Puerto Rican origin, a pattern that differs from that of the other national-origin groups and probably reflects the unique circumstances of Puerto Ricans regarding U. Studies show that Hispanics are less likely than non-Hispanic whites to have a usual source of care Hargraves, Cunningham, and Hughes,and more than one-third of immigrants lack a usual source.
Prenatal Care Early and continuous prenatal care is thought to ti good health outcomes for both mothers and infants. For example, studies lookking found eoom satisfaction is associated with health care utilization, patient compliance with provider recommendations, and willingness to initiate malpractice litigation Sherbourne, Hays, Ordway, DiMatteo, and Kravitz, ; Vaccarino, ; Zastowny, Roghmann, and Cafferata, Differences in rates of employer-provided coverage have been documented by national origin, nativity, length of residence in the United States, and language Schur and Feldman, Growth in the of uninsured Hispanics, in turn, will place increasing stress on the so-called health care safety net.
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Medical Care. Studies of hospitalization rates have yielded mixedwith some studies finding similar rates for Hispanics and whites and others finding lower rates for Hispanics e. Thus the narrowing of disparities in prenatal care oooking Hispanics and whites during the s is noteworthy, especially in light of the high proportion of Hispanics who lack health insurance. Nativity, time since arrival, and citizenship are also associated with having a physician's office as the usual source of care.
Hispanics who spoke Spanish reported worse experiences than whites with regard to timeliness of care, provider communication, staff helpfulness, and health plan service, whereas Hispanics who spoke English reported rpom similar to those of whites.
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A likely explanation for the shrinking gap in childhood vaccination rates is the Vaccines for Children program, which was created in and provides vaccines free of charge to eligible children, including uninsured children Centers for Disease Control and Prevention, In71 percent of Hispanic women began prenatal care in their first trimester, compared with 87 percent of white women; inthe proportions who began prenatal care in the first trimester were 76 percent and 89 percent, respectively.
Others, however, underscore a persistent gap in prenatal care between women with private and with public insurance coverage Braveman, Bennettt, Lewis, Egerter, and Showstack, These studies have also documented differences across Hispanic subgroups defined by national origin. This is due to much higher rates of employer-sponsored coverage for working-age adults who prefer English, combined with a minimal difference in Medicaid coverage by language preference.
Some cities do both simultaneously, protecting existing Rentt while making it virtually impossible to create new ones. Errors in interpretation may have clinical consequences Flores et al.
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As anticipated, nativity, time since arrival in the United States, and citizenship are associated with health insurance eoom Table Puerto Rican working-age adults who prefer Spanish have a much higher rate of Medicaid coverage than those who prefer English; as a result, the difference in uninsured rates by language preference is much smaller for Puerto Ricans than for the other groups. Overall, Hispanics who prefer Spanish are twice as likely as those who prefer English to be uninsured 57 versus 29 percent.
Degree of acculturation, language, and immigration status all directly affect access to care.
About three-fifths of the 29 percentage-point gap in insurance coverage between Hispanic and white ren workers was explained by differences in the characteristics of workers and their employers, including poverty status, wages, education, and firm size. They found a gradient in patients' reports of their experiences with care according to English fluency. By contrast, the proportions of Puerto Ricans and Cubans lacking a usual source of care are similar to or only slightly higher than the proportions of whites and blacks.
Thus, Hispanic males in poor, low-income, or middle-income households; those earning low wages; and those in firms with fewer than 25 workers were less likely than their white peers to have employer-provided insurance.
Several recent studies have compared process quality of care for Hispanic and white Medicare beneficiaries enrolled in Medicare managed care plans e. There are few studies of differences in medical care expenditures between Hispanics and non-Hispanic whites.
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Using data from a primary care clinic, Rivadeneyra and colleagues found that providers more often ignored comments from Spanish-speaking patients who used an interpreter than from English speakers. Finally, Table shows the relationship between language preference and having a usual source of care.
Foreign-born Hispanics consistently have much latiino access indicators than Hispanics born in the United States, except in the case of Puerto Ricans, for whom nativity makes little difference. Knowledge gaps and difficulties with the enrollment process have been identified as important causes of incomplete SCHIP uptake among all children Kenney and Haley, ; these factors are likely to be even more important for Hispanic children. In fact, English speakers appear to have care experiences that are very similar to those of non-Hispanic whites.
In particular, having a usual source of care provides a locus of entry into the complex health care delivery system when care is needed and serves as the link to more specialized types of care Lewin-Epstein, Furthermore, the use of interpreters improves the care experiences of Hispanics who speak Spanish, but even with interpreters the experiences of Spanish speakers lag those of English speakers.
The industries and occupations in which Hispanics commonly work are less likely than others to offer health insurance as a benefit of employment. These patterns are also found in Hispanic groups defined by national origin, with the exception of Puerto Ricans. Usual Source of Care Not having a usual source of health care is another key barrier to health care access.