Academic journal article Health Care Financing Review

Health Care Use by Hispanic Adults: Financial vs. Non-Financial Determinants

Academic journal article Health Care Financing Review

Health Care Use by Hispanic Adults: Financial vs. Non-Financial Determinants

Article excerpt

BACKGROUND

Lower rates of health care use by Hispanics compared with non-Hispanic white persons--in terms of hospitalizations, physician visits, prescribed medicines, and specific preventive services--have been found .n numerous studies (Andersen et al., 1981; Schur, Bernstein, and Berk, 1987, Solis et al., 1990; Harlan, Bernstein, and Kessler, 1991). A variety of explanations have been offered, from financial factors such as differences in rates of insurance coverage and economic status to non-financial influences including culturally based attitudes toward health care and barriers presented by language. It has been hypothesized that Hispanics who are less assimilated into U.S. culture face more extensive barriers to health care than those Hispanics who have become acculturated. although there is considerable empirical evidence for a variety of populations that insurance coverage, in particular, has a substantial impact on use of services, the empirical evidence on the relationship between culture and use of services is quite mixed (Andersen et al., 1981; Marks et al., 1987; Estrada, Trevino, and Ray, 1990). In other words, there is a consensus that insurance status has a strong impact on use of health care services; the question of whether culture affects use and, if it does, what its effect is relative to insurance remains unanswered. Because the policy levers needed to address financial barriers to care (e.g., insurance market reforms) are different from tools that would be used to affect cultural barriers (e.g., training of minority health personnel), it is important to identify specific factors that affect the use of health care services for this vulnerable population. The purpose of this article is to add to the body of empirical evidence on the role of cultural versus financial determinants of health care use for Hispanics.

A variety of indicators have been used to measure cultural differences or differences in the extent of assimilation within the Hispanic population. Some of the more commonly employed variables include primary spoken or written language, country of birth for respondent and/or parents, length of time in the United States, use of folk practitioners, and frequency of contact with homeland. Several studies provide evidence that language and other cultural indicators are associated with lower use rates for specific preventive services (Solis et al., 1990; Harlan, Bernstein, and Kessler, 1991). Solis and colleagues (1990) concluded, however, that traditional access measures such as having a USOC and insurance coverage were better predictors of use than was the level of acculturation. In a study comparing Hispanics and non-Hispanic white persons under a prepaid, capitated system where financial barriers are presumably removed, Perez-Stable et al. (1994) found that "acculturation, Latino subgroup, and birthplace were not significant predictors for use of any of the cancer screening tests." At the same time, Latinos were more likely than non-Latino white persons to give "embarrassment" or "fear of results" as a reason for not having had the tests. These reasons may be dimensions of cultural upbringing and attitude that are not easily captured in quantitative analysis.

The complex interrelationships among cultural indicators and sociodemographic characteristics that are historically associated with disadvantaged populations make it particularly difficult to assess the relationship between culture and use of services. Hispanics who are less assimilated are often poorer and less educated than their more assimilated counterparts--attributes that are themselves linked to lower health care use.(1) This makes the task of understanding causality quite difficult. For example, persons who are monolingual Spanish speakers are, on average, less educated and less likely to be employed than are Hispanics who speak English (Schur and Albers, in press). Both education and employment status are negatively correlated with the likelihood of being insured and, in fact, those who speak Spanish only are less likely to have private coverage. …

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