Sick in America: Hispanics Grapple With Cost And Quality Of Care

In our recent poll on what it means to be sick in America, one ethnic group stands out as having special problems � Hispanic Americans.

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The national survey, conducted by NPR with the Robert Wood Johnson Foundation and the Harvard School of Public Health, sheds new light on Hispanics' health issues. It runs counter to the widespread impression that African-Americans are worst-off when it comes to the cost and quality of health care.

Take the pocketbook issue. When we asked about the burden of out-of-pocket costs � the medical bills not covered by insurance or any government program � 42 percent of Hispanics say this is a "very serious" problem for them.

That's more than twice the proportion of non-Hispanic whites with recent illness who say so, and 8 percentage points higher than African-Americans.

 

Robert Blendon of Harvard, who helped design the poll, says Hispanics "are more likely to be uninsured or have insurance with big holes in it than African-Americans."

That may be, he says, because Hispanics are more likely to live in rural areas or in cities where fewer supports are available for uninsured or poorly insured people. "A lot of Hispanics work for small businesses with terrible insurance or none at all," Blendon notes.

The National Alliance for Hispanic Health says that Hispanics are more likely to lack health insurance than any other group � 31 percent are uninsured, compared to 21 percent of non-Hispanic blacks and 12 percent of non-Hispanic whites.

Other recent data show that nearly half of all Hispanics are on Medicaid or income-eligible for the program, a safety net for the poor and near-poor. That's higher than any other U.S. racial or ethnic group. (Hispanics are also highest in being eligible for Medicaid but not enrolled.)

Elderly Hispanics are also less likely than other groups to be on Medicare.

That all fits with another finding from the Sick in America poll. Among Hispanics who've been seriously ill within the past year, one in four say they weren't treated as well because of their health insurance situation. That's almost twice as many as recently sick whites.

Hispanics report more problems with the quality of their care too.

An unusual feature of the Sick in America poll is that it compared the experience and opinions of Americans who have been hospitalized within the past year or had serious illness requiring "a lot of medical care" with those without major illness.

Most polls don't separate out the sick and the well, so the problems of those with recent experience of the U.S. health care system can be masked.

It turns out thatnearlytwice as many Hispanics with recent illness (42 percent) say their care was poorly managed than sick whites (23 percent).

Hispanics are far more likely to say they had to wait for test results (32 percent) compared to whites (19 percent) or blacks (15 percent).

And Hispanics are much more likely to say they didn't get access to the latest technology (29 percent) than whites (12 percent) or blacks (13 percent).

Blendon says there's no evidence that Hispanics have higher expectations of health care than other groups, which could explain these perceptions. "My gut feeling is that they would have lower expectations," he says.

The Harvard researcher, an expert on public opinion and health care, predicts that these previously uncovered perceptions about health care among Hispanics are likely to become more visible.

"Hispanics are becoming a greater proportion of the US population and are having more influence in politics and policy," Blendon says. "So their concerns about health care are likely to be heard more widely in the future."