CDC data shows the numbers of uninsured are at their lowest point in 15 years. But research reveals that efforts to improve access to healthcare to a key portion of the Latino population have failed.
As the Patient Protection and Affordable Care Act turns five years old, federal health officials have been keen to point out the sweeping law's impact on the uninsured. Earlier this week the CDC released figures showing uninsured numbers are at their lowest point in 15 years, but a new survey reveals that efforts to improve access to a key portion of the Latino population have failed.
The Latino population is one of the country's largest ethnic minority groups; however, it remains one of the groups with the highest uninsured rates. The PPACA is helping make a dent in that rate, but a new survey shows there is still considerable work to do to reach this growing group of patients.
The Robert Wood Johnson Foundation Center for Health Policy at the University of New Mexico recently a poll of more than 1,400 Latino adults to assess, in part, the impact of the PPACA. The interviews were long, on average they lasted more than 20 minutes, and were conducted in English and Spanish. The questions also aimed to measure Latinos' attitudes toward immigration policies and community connections.
The poll found that 82% of those polled reported having insurance. Gabriel Sanchez, PhD, executive director of the RWJF Center for Health Policy at UNM and director of Research at Latino Decisions, a research firm focused on Latino opinion polling, says that is the highest percentage of insured Latinos since polling of this population began in 2008.
"The ACA, in terms of expanding access to the Latino population, is clearly working," says Sanchez.
The survey results also pointed to more Latinos having insurance without interruption. Sanchez says 64% reported being insured for 12 consecutive months, which is also an improvement over previous years.
Getting Left Behind
There are many similarities between the RWJF findings and other populations in the data collected. For example, most Latinos are insured through their employers (38%). Medicare was the second most common source of insurance coverage (19%) followed by Medicaid (12%).
However, the newest insurance coverage option—health insurance exchanges—accounts for covering only 8% of those polled. The main reason that number is so low among Latinos is because the respondents had not heard of the exchanges.
"One in four Latinos, or 25% indicate that they literally heard nothing at all about the exchanges or [health insurance] marketplaces," says Sanchez. "That's an important number because although the ACA is clearly working and increasing access… there's still a pretty large segment of the Latino population that is not being touched by that outreach effort."
Sanchez says he wanted to dig deeper into the exchange data for this population, and found that a key age group the federal government was aiming for to help stabilize the exchanges reported the least amount of awareness. The survey found that 67% of Latinos in the 18–34 age group reported limited or zero knowledge about the exchanges. It is, ironically, this group that the administration needs the most.
"A lot of emphasis was placed on trying to reach out to young Latinos primarily because they are a healthier segment of the population… there needs to be outreach," says Sanchez.
Dwindling Numbers of Physicians
It likely needs to be real outreach rather than a simple brochure printed in Spanish. Physicians play an important role. Although the most recent poll results do not examine Latino patients' relationships with physicians, Sanchez says he has explored the option in the past.
"In our 2013 survey, we asked Latinos, 'Where do you prefer to acquire information about the Affordable Care Act?' And doctors were the most trusted messenger."
Among those most trusted messengers are Latino physicians, who understand the cultural needs and norms that exist with this population. The numbers of Latino doctors are declining, however, which, when coupled with the increasing demand and need for them, means a potentially looming health crisis.
A recent study from the UCLA's Center for the Study of Latino Health and Culture showed a significant drop in Latino physicians from 1980 to 2010. The rate of non-Hispanic white physicians grew from 211 per 100,000 people to 315. The rate of Latino physicians went from 135 per 100,000 people to 105 over the same time frame. The authors of the study used census data from California, Texas, Florida, Illinois, and New York because of the high Latino populations.
While the numbers of Latino physicians declined over the 30-year period, the number of Latinos in the U.S. increased, growing from 7% of the population in 1980 to 16% in 2010. By 2060, the numbers are projected to almost triple.
When the study was published in Academic Medicine, the lead author, Gloria Sanchez, MD, [no relation to Gabriel Sanchez] associate clinical professor at UCLA's David Geffen School of Medicine, and family medicine associate residency program director, Los Angeles County Harbor–UCLA Medical Center, said that dwindling numbers of Latino physicians could adversely affect patients because as physicians' numbers decline, they take with them valuable language skills and cultural familiarity that allows effective communication, and Sanchez says the need for more Hispanic physicians is urgent.
"It's not just about having Latino providers, but having more providers serving the Latino population," she says.
A Way Forward
There are organizations trying to bridge the current and projected gap. The Hispanic-Serving Health Professions School (HSHPS) is a nonprofit organization that is made up of schools and/or colleges of various medical programs, such as medicine, pharmacy, nursing, and others, that aims to increase the Hispanic health workforce by providing academic and career assistance to up and coming health professionals. HSHPS has trained more than 500 health professionals, but it's clear that more are needed.
There are several things providers can do to communicate with their Latino patients. First, learn from patients by doing a community-based assessment.
"It doesn't take a lot of money, it is not hi-tech research," says Sanchez. "It's getting a patient advocacy group in your clinic to learn what the barriers to care are and what is working."
Sanchez also says having a Spanish-speaking provider in the office is "huge," because the inability to communicate with a patient allows for gaps in cultural empathy and patient care.
"We have a crisis," says Sanchez. "We aren't communicating well, and not with just Spanish-speakers, but with all patients. I advocate for people willing to be bilingual, and not just MDs, but ancillary providers, too. The [RWJF] survey shows that this issue is about having a public policy and public health approach to this population."
Jacqueline Fellows is a contributing writer at HealthLeaders Media.