Hispanics' lack of medical home goes beyond access, insurance

Washington -- Luis Padilla, MD, sees Hispanic patients who visit only when they feel sick or injured. He also sees patients prompted to visit for preventive care after seeing a Spanish-language newspaper or television report about diabetes, obesity or cancer.

Jose Cruz, a 28-year-old Hispanic patient, fits both profiles. In August he visited the Upper Cardozo Health Center in Washington, D.C., a clinic where Dr. Padilla is medical director, because Cruz's arms were "falling asleep at night" and because he was worried about his family's history of diabetes. Cruz had heard reports about the disease and other health issues through local Spanish-language media. He qualified for care at the clinic with low co-pays through DC Healthcare Alliance, a city safety-net program for the uninsured. Like nearly all patients at the center, he made his appointment the day before.

He passed a strength test and had no other indications, so Dr. Padilla was not too worried about Cruz' arms. The physician also ordered blood tests to screen for diabetic risk.

Cruz is part of a diverse and growing U.S. Hispanic adult population, now estimated at 30 million, that has many members with no regular medical home. Although it had been more than 1½ years since his last visit, Cruz went to the clinic not for a regular checkup but because he feared for his health.

Twenty-seven percent of Hispanic adults lack a regular source of care and typically rely on emergency departments for treatment, according to a survey of more than 4,000 Hispanics. The survey, released Aug. 13 by the Pew Hispanic Center, found insurance is not always the problem. Of Hispanics who lack a regular source of care, 45% reported having health coverage.

Complex causes

In some cases, the disconnect comes from access and cost issues. In others, it goes beyond that.

Patrick Dowling, MD, MPH, was not surprised that many insured Hispanics do not get regular care. The survey findings may be in part because many Hispanics tend to live in poorer urban or rural areas that have been federally designated as physician shortage areas, said Dr. Dowling, a family physician fluent in Spanish who practices at Les Kelley Family Health Center in Santa Monica, Calif.

Dr. Padilla echoed that assessment but noted other factors. "There's not enough primary care providers ... for the demand, but what we see here is that there's also competing needs. They have jobs."

Working poor Hispanics sometimes put off health care when making difficult choices about how to spend their time and money, Dr. Padilla said. Many can't afford to take time off work to visit a physician.

Others simply might not feel the need to visit a doctor for preventive services. More than 40% of Hispanic adults without a regular source of care said they are "seldom" or "never" sick, the Pew Hispanic Center survey found.

That statistic resonated with Amelie G. Ramirez, DrPH, director of the Institute for Health Promotion Research at the University of Texas Health Science Center at San Antonio. "There's a cultural sense that 'I don't have to see the doctor on a regular basis because I feel OK,' " she said.

Some Hispanics delay seeking care for fear of the diagnosis, she said. Some women wait to seek cancer treatment because they're hoping the problem will go away or because they think nothing can be done. "Our population feels that cancer equals death," said Ramirez, who works on cancer education and outreach projects.

Even Hispanics who have health coverage and who access physician services sometimes have trouble getting all of their medical needs met. Miguelina Hernandez, 71, who also visited Dr. Padilla at the clinic in August, is enrolled in both Medicare and Medicaid. She had received a hearing aid for her auditory loss, but Medicare paid for only one, and it has since broken. She visited Dr. Padilla that day because of a flare-up of her arthritis and because she saw dark floating matter in her right eye. The physician took the opportunity to schedule her for an annual eye exam with the in-house ophthalmologist.

Doctors trying to get health care information to Hispanic patients who may not have a regular physician have an ally in media outlets that target the population. Large-circulation Spanish-language newspapers such as La Opinión and TV networks such as Univision regularly offer articles and programs about health care.

Of all Hispanic adults surveyed by the Pew Hispanic Center, 83% received health care information in the last year from the media, which includes radio, newspapers, television and the Internet. In comparison, 71% received information from a health professional.

"Spanish language media ... help immigrants socially adapt to their new home country and learn how our systems work -- or don't -- in the case of health care," said Robert Otto Valdez, PhD, a professor of family and community medicine and economics at the University of New Mexico.

Ramirez has worked on TV programs for Hispanics in which physicians speak to patients about various illnesses. The programs are followed up by community newsletters with information about accessing health care.

Such media-based health information appears to reach a receptive audience and leads many people to take action, according to the Pew study. Sixty-four percent of those who received health information from the media said it changed they way they thought about diet or exercise. Fifty-seven percent said it led them to ask a medical professional new questions.

Not all the advice is sound. In the Los Angeles area, Spanish-language TV runs more ads for pills to lose weight or improve libido than does English-language TV, Dr. Dowling said. About 90% of the pills, herbs and remedies patients bring in are not harmful, but some pose a threat of adverse drug interactions.