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Michael-Rodriguez Powered By Docstoc
					Improving Healthcare
     for Latinos

          March 27, 2010
Michael A. Rodríguez, MD, MPH
Professor and Vice Chair of Research
George F. Kneller Endowed Chair in Family Medicine
UCLA Department of Family Medicine

 Network for Multicultural Research on
 Health and Healthcare funded by the
 Robert Wood Johnson Foundation
Geographic Location
of Latinos in the US
Migration Patterns Among
   Latinos 1995-2000
                      Stats about US Latinos

           More than 1 in 5 children is Latino 1
           38% (18 million people) are immigrants2
                  Majority have lived in the US for more than
                   10 years2
                  66% were of Mexican origin, 9% Puerto
                   Rican origin, 3% Cuban and 3%
                   Salvadoran origin3

1. Fry R, Passell JS. 2009. 2. Argeseanu, CS, et al., 2008 3. Passel J, Cohn D., 2009.
 Latino Epidemiological Paradox

 34% Lower heart disease mortality
 43% Lower cancer mortality
 24% Lower stroke mortality
 Identical low infant mortality
Immigrants Face many Challenges

 Low Socio-economic Status
 Living conditions
 Nutrition
 Low educational attainment
 Language
        Four Areas of Unmet
         Health Care Needs
 Low quality of health care
 Inadequate health insurance coverage
 Language barriers in the US healthcare
  delivery system
 Lack of diversity among healthcare
Low Quality of Healthcare

 Poorer quality of health care than non-
  Latino Whites on 19 of 34 measures.
      heart attacks, diabetes, pneumonia, htn,
       depression, HIV

 Latino children also suffer disparities
    shorter average visit duration, lower odds
     of receiving any counseling during well-
     child visits, less parental satisfaction,
     greater unmet need for mental health
          Inadequate Health
         Insurance Coverage
 Latinos have the highest rates of being
  uninsured or underinsured
 In 2008, 32% of Latinos, 19% of African
  Americans, and 18% of Asians in the US
  lacked health insurance, compared with
  10% of non-Latino Whites.

    DeNavas-Walt C, Proctor BD, Smith JC. 2009
 Coverage is particularly low among
  undocumented immigrants
      63%   lack health insurance1
 Latinos 65 years and older account for
  64% of all uninsured older Americans2

      1. Rodríguez MA, Bustamante AV, Ang A. 2009
      2. Mold JW, Fryer GE, Thomas CH. 2004
                          Health Insurance, Access and
                          Health Status of Children, by
                         Parents’ Immigrant Status, 1999

Note: Children of immigrants are defined as those with one or more foreign -born parents. 78% of children born to immigrants
are U.S. born citizens. Low-income is less than 200% of FPL or $26,760 for a family of three. Data: The 1999 National Survey of
America’s Families, Urban Institute. SOURCE: Capps, 2001.
Language Barriers

 Limited English proficiency (LEP)
    lower quality of interpersonal care
    lower patient satisfaction, excessive
     ordering of medical tests, lack of
     understanding of medication side effects
     and instructions, more frequent medical
     errors, decreased use of primary care,
     increased use of the emergency
     department, and inadequate follow-up.
    quality is compromised and more costly
     Language Access Issues

 Title VI of the Civil Rights Act of 1964,
  mandates that all healthcare providers
  receiving federal funding (including
  Medicare or Medicaid) provide adequate
  language services to all patients
 Health care system serves nearly 16
  million Latinos with LEP and 22 states
  have more than 100,000 residents who
  are LEP Spanish speakers.
 The Centers for Medicare & Medicaid Services
  (CMS) allow states to include language
  services as an optional covered service under
  Medicaid and the Children’s Health Insurance
  Program (CHIP).
      Only DC and 13 states (Hawaii, Idaho, Iowa,
       Kansas, Maine, Minnesota, Montana, New
       Hampshire, Utah, Vermont, Virginia, Washington,
       and Wyoming) provided 3 rd party reimbursement
       for language services through Medicaid and CHIP
       in 2009
       Lack of diversity among
       Healthcare Professionals
 Minority patients are more satisfied with
  the health care when received from
  minority professionals of the same
 Latinos are significantly
  underrepresented in the health
  professional workforce in all US states.
     Latinos account for only 3.5% of physicians,
      2.0% of registered nurses
      Healthcare Environment

 Supply of clinicians

 The clinical environment

 Accessibility to healthcare providers
  Policy Priorities to
 Improve Access to
and Quality of Health
   Care for Latinos
      Two Visions of America
 Integration model: wants to invest in
  immigrants; views immigrants as a vital
  part of our society; recognizes economic,
  social and cultural contributions of
  immigrants to U.S. society.
 Marginalization model: wants to reverse
  the flow of immigration; creates division
  between immigrants and citizens,
  documented and undocumented
  immigrants, population stalls.
    Implications of the Federal
      Debate on Immigration
 Regardless of the outcome, immigrant
  families will continue to represent a
  significant portion of our workforce, child
  and student population
 Continued investment in immigrant
  services will maximize contributions to
  the general public health, increase
  families’ self-sufficiency, reduce SS
      Provide Affordable Health
      Insurance Coverage to All US
•Universal health insurance coverage

•Legislation that does not limit who may participate
 in coverage

•Decoupling healthcare policy from the politics
of immigration control
Enhance the Delivery of
Linguistically Appropriate Care
 Require reimbursement for language
  services and enforce adherence
 Improve and disseminate services for
  Diversify the Healthcare and
  Research Workforce

 Pipeline with stronger gov’t support

 IMG option
Improve Data and Systems to
Define and Monitor Disparities
Affecting Latinos

 Support recommendations 2009 IOM
 report on Race, Ethnicity and Language
 Severe disparities in health care
 Contribute to future excess morbidity or
  mortality, as well as increased exposure
  to infectious diseases and higher
  healthcare costs for all
 Need for equitable distribution of
  resources, including health insurance for
  the entire US population,
 Such policy efforts at the federal,
  regional and local health system levels
  will improve the quality of health care for
  Immigrants and all Americans
       Thank You

Michael A. Rodríguez, MD, MPH