Growing Hispanic populations present health care challenges
■ Low rates of insurance and too few safety net facilities are two barriers to care, a new study found.
By Doug Trapp — Posted Oct. 16, 2006
Washington -- Until about 10 years ago, Wayne Hale, MD, didn't have much contact with North Carolina's migrant laborers. They worked in rural areas and only came in for care when injured.
Since then, especially in the last five years, many more Hispanic families have moved to Greensboro, N.C., where he practices, said Dr. Hale, an associate professor of family medicine at the Moses Cone Health System Family Medicine Program.
"In fact, the predominant people we see in our clinics are Hispanic women and children," Dr. Hale said. Men are still seen more often outside office hours in the emergency department, he said.
Greensboro is not alone.
Cities, towns, and rural areas around the United States not known for Hispanic populations have seen a relative boom in the last decade, according to a recent report from the Kaiser Commission on Medicaid and the Uninsured.
While the Hispanic population increased across the country, these "new growth communities," as the report calls them, saw sharper spikes.
About 4 million Hispanics lived in these areas in 1996. By 2003, that jumped to 7.8 million, boosting their overall share of the U.S. Hispanic population from 14% to 20% during the same years, the report said. In Greensboro, N.C., for example, about 1% of the population was Hispanic in 1996, but that rose to 4.9% by 2003.
Although Hispanics still represent only about 5% of residents in these new growth communities, the trend raises questions about what kind of access to health care they have.
The Kaiser report, based on a telephone survey, found problems.
For example, the proportion of uninsured Hispanics in the growth areas increased from 25% in 1996-1999 to 31% in 2000-2003. The likely reason is that many of these residents are new immigrants with low-paying jobs who either aren't offered coverage at work or if they are, can't afford it, the report stated.
"It's a difficult thing, but we certainly have people that end up getting admitted to the hospital because they didn't take the medicine because they couldn't afford it," Dr. Hale said. "But that's a problem with the whole U.S. medical system."
Dr. Hale estimated that less than half of Hispanic children he sees qualify for Medicaid. Legal immigrants must have five years of residency before they are eligible for Medicaid or the State Children's Health Insurance Program.
While Hispanics all over the United States had about the same access to a regular source of health care, those in new growth communities were more likely to use emergency departments and experience communication problems with physicians, the survey found.
Less access, insurance
New growth areas generally don't have the clinics and other social services of large cities with established Hispanic populations, according to Peter J. Cunningham, senior fellow at the Center for Studying Health System Change and one of the report's co-authors.
Also, only about half of the Hispanics in new growth communities live within 10 miles of a hospital equipped to provide care to immigrants, compared with 82% of those in major Hispanic centers.
In Greensboro, the health community has developed some programs tailored to this population. The Moses Cone Family Medicine Residency Program runs a Monday afternoon clinic for Spanish-speaking patients to give its 24 medical residents a chance to learn how to interact with them. Some of the medical residents have a chance to visit rural Honduras to get a better feel for how people there live, which is not all that different from Mexico, where most of the clinic's patients are from.
Dr. Hale said some area Hispanics work in factories and have insurance. For others, local programs help families pay for clinic visits, medication and tests at the Annie Penn Hospital. Volunteer specialty care is available through Greensboro's Project Access.
"It's a patchwork system," Dr. Hale said.
Dr. Hale, who has taught at the program for 20 years, believes most of the Hispanic patients he sees have been in the United States for an average of five or six years. Some may have relocated from other parts of the country, he said.
"So far I think [Greensboro has] been a more welcoming environment for them, and there's certainly been plenty of work," he said.
Culture affects care
There's more than a language barrier separating some doctors from Hispanic patients. Hispanics, especially men, tend to be more stoic.
While they may complain about stomachaches or headaches, the symptoms may have more to do with their family situation or other issues rather than a medical condition, Dr. Hale said. They may have been abused somehow on their trip into the United States, or they may be separated from their children, who they are trying to support financially.
"They give physical complaints when the true problem actually relates to stress. We're dealing with people who have tremendous stresses," Dr. Hale said.