Hispanics and Health Care in the United States: Access, Information and Knowledge

A Joint Pew Hispanic Center and Robert Wood Johnson Foundation Research Report

by Gretchen Livingston, Senior Researcher and Susan Minushkin, Deputy Director, Pew Hispanic Center and D'Vera Cohn, Senior Writer, Pew Research Center
August 13, 2008

Overview and Executive Summary

More than one-fourth of Hispanic adults in the United States lack a usual health care provider, and a similar proportion report obtaining no health care information from medical personnel in the past year. At the same time, more than eight-in-ten report receiving health information from alternative sources, such as television and radio, according to a Pew Hispanic Center survey of Latino adults, conducted in conjunction with the Robert Wood Johnson Foundation.

Hispanics are the nation's largest and fastest growing minority group. They currently make up about 15% of the U.S. population, and this figure is projected to nearly double to 29% by 2050, if current demographic trends continue.¹ Even after adjusting for their relative youth, Hispanic adults have a lower prevalence of many chronic health conditions than the U.S. adult population as a whole. However, they have a higher prevalence of diabetes than do non-Hispanic white adults, and they are also more likely to be overweight. This greater propensity to be overweight puts them at an increased risk to develop diabetes and other serious health conditions.²

Previous research by the U.S. Centers for Disease Control and Prevention has shown that Hispanics are twice as likely as non-Hispanic blacks and three times as likely as non-Hispanic whites to lack a regular health care provider.³ Hispanics are a diverse community, and the Pew Hispanic Center/Robert Wood Johnson Foundation Latino Health survey of 4,013 Hispanic adults explores not only their access to health care, but also their sources of health information and their knowledge about a key disease (diabetes) at greater depth and breadth than any national survey done to date by other research organizations or the federal government.

It finds that among Hispanic adults, the groups least likely to have a usual health care provider are men, the young, the less educated, and those with no health insurance. A similar demographic pattern applies to the non-Hispanic adult population. The new survey also finds that foreign-born and less-assimilated Latinos -- those who mainly speak Spanish, who lack U.S. citizenship, or who have been in the United States for a short time -- are less likely than other Latinos to report that they have a usual place to go for medical treatment or advice. Nevertheless, a significant share of Hispanics with no usual place to go for medical care are high school graduates (50%), were born in the United States (30%) and have health insurance (45%). Indeed, the primary reason that survey respondents give for lacking a regular health care provider is not related to the cost of health care or assimilation. Rather, when asked about why they lack a usual provider, a plurality of respondents (41%) say the principal reason is that they are seldom sick.

As for sources of health information, about seven-in-ten Latinos (71%) report that they received information from a doctor in the past year. An equal proportion report obtaining health information through their social networks, including family, friends, churches, and community groups. An even larger share (83%) report that they obtained health information from some branch of the media, with television being the dominant source. Not only are most Latinos obtaining information from media sources, but a sizeable proportion (79%) say they are acting on this information. It is beyond the scope of this report to assess the accuracy and usefulness of health information obtained from non-medical sources, but the survey findings clearly demonstrate the power and potential of these alternative outlets to disseminate health information to the disparate segments of the Latino population.

Regarding the quality of the health care they receive, Latinos are generally pleased, according to the survey. Among Latinos who have received health care in the past year, 78% rate that care as good or excellent. However, almost one in four who received health care in the past five years reported having received poor quality medical treatment. Those who believed that the quality of their medical care was poor attribute it to their financial limitations (31%), their race or ethnicity (29% ) or the way they speak English or their accent (23%).

The survey also asked respondents a battery of eight knowledge questions about diabetes, a condition that afflicts an estimated 9.5% of Latino adults, compared with 8.7% of non-Latino whites.⁴ Nearly six in 10 respondents (58%) answered at least six of the eight diabetes questions correctly. Better educated and more assimilated Latinos scored better, as did those with a usual health care provider.

These findings are from a bilingual telephone survey of a nationally representative sample of 4,013 Hispanic adults conducted from July 16, 2007 through September 23, 2007. The survey's margin of error is +/- 1.83 (see Appendix A for a full description of the survey methodology).

Among the key findings:

The Likelihood of Having a Usual Health Care Provider

Some 73% of Latino adults report having a usual place where they seek medical help or advice, while 27% have no usual health care provider.

As in the general population, males, the young, and the less educated are less likely to have a usual health care provider.

• 36% of men lack a usual provider, compared with 17% of women.
• 37% of persons ages 18-29 lack a regular place to obtain health care, compared with 13% of persons ages 65 or older.
• 32% of adults with less than a high school diploma lack access to a regular place for health care, compared with 19% of people with at least some college education.

Foreign-born and less-assimilated Latinos are less likely than other Hispanics to have a usual health care provider.

• 30% of Latinos born outside of the 50 states lack a usual place for health care, compared with 22% of U.S.-born Latinos.
• 32% of Latinos who mainly speak Spanish lack a regular health care provider, compared with 22% of Latinos who mainly speak English.
• 49% of Latinos who have lived in the United States for less than five years lack a usual health care provider, compared with 21% of those who have lived in the United States for 15 years or more.

Some 42% of the Latinos who have no health insurance lack a usual health care provider, compared with 19% of the insured.

Profile of Persons Who Lack a Usual Health Care Provider

The primary reason that respondents give for not having a regular health care provider is their belief that they do not need one.

• 41% of those lacking a regular provider say that they are seldom sick, and 13% say they prefer to treat themselves.
• 17% report a lack of health insurance as the primary reason that they don't have a regular provider, and 11% report that the cost of health care is prohibitive.
• 3% report that they have trouble navigating the U.S. health care system.

A significant share of Hispanic adults who lack a regular health care provider are native born, have a high school diploma, speak English and have health insurance.

• 50% of those with no usual health care provider are at least high school graduates.
• 30% of those with no usual health care provider were born in the United States.
• 52% of those with no usual health care provider speak predominantly English or are bilingual.
• 45% of those with no usual health care provider have health insurance.

Quality of Health Care

77% of Latinos who have received health care in the past year rate that care as good or excellent.

Of those Latinos who have received health care in the past year, assessments of the quality of care are higher rated among those who have health insurance and a usual health care provider.

• 80% of people with a usual health care provider state that their health care was good or excellent, compared with 64% of people with no usual health care provider.
• 80% of the insured rate their health care as good or excellent, compared with 70% of the uninsured.

Of those respondents who have received health care in the past five years, 23% report having received poor-quality medical treatment

• A plurality (31%) attribute this poor treatment to their financial limitations.
• 29% attribute the poor treatment to their race or ethnicity.
• 23% report that their accent or the manner in which they speak English contributed to their poor treatment.

Health Information Sources

Some 71% of Latinos report getting information from a medical professional in the past year, while 28% report having obtained no information at all from a health care professional in that time.

Most Latinos receive information about health care either from the media, or from their families, friends, churches and community groups.

• 83% report obtaining at least some information about health and health care from television, radio, newspapers, magazines or the Internet in the past year.
• 70% report obtaining information from family and friends, or churches and community groups in the past year.

Television is an especially powerful conduit of information; 68% of Latinos report obtaining health information from television in the past year.

Not only are Latinos obtaining a substantial amount of health information from the media, but they are making behavioral changes based on what they learn.⁵

• 64% report that the health information that they obtained from the media led them to change their diet or exercise regimes.
• 57% report that the health information they obtained from the media led them to visit a health care professional.
• 41% say that the information they obtained from the media affected their decision about how to treat an illness or medical condition.

Diabetes Knowledge

In a battery of eight questions assessing diabetes knowledge, 58% of respondents scored "high," meaning they correctly answered six or more of the questions.

Better-educated, more-assimilated Latinos are more knowledgeable about diabetes.

• 50% of adults lacking a high school diploma score high on the knowledge battery, compared with 70% of adults with at least some college education.
• 60% of naturalized citizens score high on the knowledge battery, compared with 48% of immigrant respondents who are neither citizens nor legal permanent residents.
• 50% of immigrants who have lived in the United States for less than five years score high on the knowledge battery, compared with 61% of immigrants who have lived in the United States for 15 years or more.

61% of adults with a usual place for health care scored high on the diabetes knowledge index, compared with 50% of adults with no usual place for health care.

Among adults diagnosed with diabetes, 73% scored high on the knowledge test, while 27% answered five or fewer questions correctly.

Read the full report including detailed findings and survey methodology at pewhispanic.org.

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Notes

¹ Passel J, and Cohn D'Vera. "U.S. Population Projections: 2005-2050." Pew Research Center, 2008.
² American Diabetes Association. www.diabetes.org Accessed 6/18/2008.
³ Pleis JR, and Lethbridge-Cejku M. "Summary Health Statistics for U.S.Adults: National Health Interview Survey, 2006." National Center for Health Statistics Vital and Health Statistics Series 10:235, 2007.
⁴ National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2005. Centers for Disease Control and Prevention, 2005. These figures represent the overall prevalence of diabetes. For age-adjusted statistics on the prevalence of diabetes, see Table 1.
⁵ The survey does not allow us to evaluate the validity of the health information obtained, or the appropriateness of subsequent behavioral changes that respondents make.