RESUMEN
In the new Affordable Care Act (ACA) health care environment, safety-net institutions continue to serve as important sources of culturally appropriate care for different groups of immigrant patients. This article reports on a qualitative study examining the early ACA enrollment experiences of a range of health care providers (n = 29) in six immigrant-serving safety-net clinics in New Mexico. The six clinics configured their ACA enrollment strategies differently with regard to operations, staffing, and outreach. Providers reported a generally chaotic rollout overall and expressed frustration with strategies that did not accommodate patients, provided little training for providers, and engaged in minimal outreach. Conversely, providers lauded strategies that flexibly met patient needs, leveraged trust through strategic use of staff, and prioritized outreach. Findings underscore the importance of using and funding concerted strategies for future enrollment of immigrant patients, such as featuring community health workers and leveraging trust for outreach.
Asunto(s)
Emigrantes e Inmigrantes , Personal de Salud/organización & administración , Pacientes no Asegurados/etnología , Patient Protection and Affordable Care Act/organización & administración , Proveedores de Redes de Seguridad/organización & administración , Actitud del Personal de Salud , Humanos , New Mexico , Estados UnidosRESUMEN
The objective of this article is to quantify quality improvement using data from a randomized controlled trial that tested the effectiveness of a community health worker in the primary role of diabetes educator in a clinic serving uninsured Mexican Americans. The intervention group received 7 hours of diabetes education/case management in excess of usual medical care. Of 16 process and outcome measures evaluated, the intervention group was significantly more likely to have received a dilated retinal examination, and 53% achieved a hemoglobin A1c below 7% compared with 38% of the control group participants. Composite quality measures were similar in magnitude with published practice-based benchmarks at study conclusion. This suggests that the overall diabetes care delivered in this clinic serving uninsured patients was comparable to the levels of excellence achieved in other primary care settings. Quantitative measurements of quality improvement can inform health policy regarding the relative effectiveness of diabetes interventions.
Asunto(s)
Agentes Comunitarios de Salud , Diabetes Mellitus , Pacientes no Asegurados/etnología , Educación del Paciente como Asunto/normas , Mejoramiento de la Calidad , Adulto , Femenino , Hemoglobina Glucada/análisis , Humanos , Masculino , Americanos Mexicanos , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Evaluación de Programas y Proyectos de SaludRESUMEN
OBJECTIVES: We examined the prevalence of actions taken to control blood pressure as measured by taking antihypertensive medication or making lifestyle modifications among hypertensive adults residing along the Texas/Mexico border. METHODS: We used self-reported data from the 2007 Texas Behavioral Risk Factor Surveillance System, with oversampling of border counties. We calculated the age-standardized prevalence of actions taken to control hypertension by selected characteristics. RESULTS: In analyses that combined ethnicity with predominant language spoken, those least likely to take any action to control their blood pressure--either by taking an antihypertensive medication or by making any of four lifestyle modifications--were Spanish-speaking Hispanic people (83.2% ± 2.7% standard error [SE]), with English-speaking non-Hispanic people (88.9% ± 0.8% SE) having the highest prevalence of taking action to control blood pressure. When analyzed by type of medical category, uninsured Hispanic people (63.8% ± 4.8% SE) had the lowest prevalence of taking action to control their blood pressure compared with uninsured non-Hispanic people (75.4% ± 4.7% SE). Nonborder Texas residents with hypertension were more likely to take antihypertensive medications (78.4% ± 1.0% SE) than border county residents with hypertension (70.7% ± 2.0% SE). CONCLUSIONS: Public health efforts must be undertaken to improve the control of hypertension among residents of Texas counties along the Mexico border, particularly for uninsured Hispanic people.
Asunto(s)
Antihipertensivos/uso terapéutico , Hispánicos o Latinos/estadística & datos numéricos , Hipertensión/prevención & control , Lenguaje , Pacientes no Asegurados/estadística & datos numéricos , Conducta de Reducción del Riesgo , Adolescente , Adulto , Anciano , Sistema de Vigilancia de Factor de Riesgo Conductual , Estudios Transversales , Femenino , Geografía/estadística & datos numéricos , Hispánicos o Latinos/etnología , Humanos , Hipertensión/epidemiología , Hipertensión/etnología , Masculino , Pacientes no Asegurados/etnología , México , Persona de Mediana Edad , Prevalencia , Autoinforme , Texas/epidemiología , Adulto JovenRESUMEN
Barriers in seeking access to conventional health care services continue to be a problem in the United States, especially among recent racial and ethnic immigrants who tend to be least able to afford adequate health insurance coverage. Ethnic immigrants sometimes seek out traditional healers as unconventional providers of health care services to overcome barriers in accessing the conventional health care delivery system. The purpose of this work is to provide insight into the practices of Picuristes or Haitian "lay injectionists" in their role as alternative, unconventional providers of health care services among Haitian immigrants in South Florida. Based on in-depth interviews with 10 picuristes who were identified through venue and snowball sampling and who volunteered to participate in a larger exploratory study that examined various aspects of picuriste practices, findings revealed benefits and risks of seeking health care services from these traditional practitioners. Among the benefits reported to their services were greater accessibility, affordability, convenience, and cultural compatibility. Risks observed from analysis of picuriste interviews included the lack of formal medical training for picuristes, their nonadherence to established standards for safe injections and their potential to expose clients and the community to contaminated needles, syringes, and other biohazardous waste materials. Insight was also gained into how picuristes learned to practice their trade and to incorporate Haitian cultural beliefs regarding the relationship between clients and healers. Given the continuation of barriers to health care among ethnic immigrants, implications for conventional heath care practice and social policy are also discussed.
Asunto(s)
Emigrantes e Inmigrantes , Accesibilidad a los Servicios de Salud/economía , Medicina Tradicional/estadística & datos numéricos , Aceptación de la Atención de Salud/etnología , Adulto , Cultura , Femenino , Florida , Haití/etnología , Humanos , Inyecciones/efectos adversos , Inyecciones/estadística & datos numéricos , Entrevistas como Asunto , Masculino , Pacientes no Asegurados/etnología , Medicina Tradicional/economía , Investigación CualitativaRESUMEN
Despite the growing prevalence of transnational medical travel among immigrant groups in industrialized nations, relatively little scholarship has explored the diverse reasons immigrants return home for care. To date, most research suggests that cost, lack of insurance and convenience propel US Latinos to seek health care along the Mexican border. Yet medical returns are common even among Latinos who do have health insurance and even among those not residing close to the border. This suggests that the distinct culture of medicine as practiced in the border clinics Latinos visit may be as important a factor in influencing medical returns as convenience and cost. Drawing upon qualitative interviews, this article presents an emic account of Latinos' perceptions of the features of medical practice in Mexico that make medical returns attractive. Between November 15, 2009 and January 15, 2010, we conducted qualitative interviews with 15 Mexican immigrants and nine Mexican Americans who sought care at Border Hospital, a private clinic in Tijuana. Sixteen were uninsured and eight had insurance. Yet of the 16 uninsured, six had purposefully dropped their insurance to make this clinic their permanent "medical home." Moreover, those who substituted receiving care at Border Hospital for their US health insurance plan did so not only because of cost, but also because of what they perceived as the distinctive style of medical practice at Border Hospital. Interviewees mentioned the rapidity of services, personal attention, effective medications, and emphasis on clinical discretion as features distinguishing "Mexican medical practice," opposing these features to the frequent referrals and tests, impersonal doctor-patient relationships, uniform treatment protocols and reliance on surgeries they experienced in the US health care system. While interviewees portrayed these features as characterizing a uniform "Mexican medical culture," we suggest that they are best described as unique to the private clinics and hospitals returning migrants visit. In short, we suggest that the perceived contrast in cultures of medicine derives from the difference in organization of health care services on each side of the border.
Asunto(s)
Atención a la Salud/organización & administración , Emigrantes e Inmigrantes/psicología , Turismo Médico/psicología , Americanos Mexicanos , Aceptación de la Atención de Salud/psicología , Adulto , Atención a la Salud/economía , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Seguro de Salud/estadística & datos numéricos , Masculino , Pacientes no Asegurados/etnología , Pacientes no Asegurados/psicología , Americanos Mexicanos/etnología , Americanos Mexicanos/psicología , México/etnología , Persona de Mediana Edad , Cultura Organizacional , Aceptación de la Atención de Salud/estadística & datos numéricos , Investigación CualitativaRESUMEN
OBJECTIVE: To examine whether socioeconomic and racial/ethnic characteristics contribute independently and in combination to influence douching behavior. DESIGN: A cross-sectional design. SETTING: United States. PARTICIPANTS: Women between 14 and 49 years of age who were both interviewed and examined as part of the National Health and Nutrition Examination Survey data collection process. MAIN OUTCOME MEASURES: Douching rates in women categorized on socioeconomic and racial and ethnic characteristics. RESULTS: Based on data from 3,522 women, 21% reported recent douching. Separated by race, Black women douche at much higher percentage (47%) than non-Hispanic White (17%), Mexico-born Mexican American women (12.5%), or U.S.-born Mexican American women (19%). Although increasing age and low socioeconomic status are both associated with increased douching, the effects of socioeconomic status on douching vary by race/ethnicity. CONCLUSIONS: Low income and minority racial status contribute both independently and together to influence douching behavior in women. These findings suggest cultural contributions to douching may be especially prevalent in the Black population while Mexican American women born in Mexico may be relatively immune to U.S. cultural influences.
Asunto(s)
Actitud Frente a la Salud/etnología , Negro o Afroamericano/etnología , Americanos Mexicanos/etnología , Ducha Vaginal/psicología , Población Blanca/etnología , Mujeres/psicología , Adolescente , Adulto , Negro o Afroamericano/educación , Negro o Afroamericano/estadística & datos numéricos , Factores de Edad , Distribución de Chi-Cuadrado , Estudios Transversales , Escolaridad , Femenino , Conductas Relacionadas con la Salud/etnología , Humanos , Modelos Logísticos , Pacientes no Asegurados/etnología , Americanos Mexicanos/educación , Americanos Mexicanos/estadística & datos numéricos , México/etnología , Persona de Mediana Edad , Motivación , Investigación Metodológica en Enfermería , Encuestas Nutricionales , Factores Socioeconómicos , Encuestas y Cuestionarios , Estados Unidos , Ducha Vaginal/efectos adversos , Ducha Vaginal/estadística & datos numéricos , Población Blanca/educación , Población Blanca/estadística & datos numéricos , Mujeres/educaciónRESUMEN
OBJECTIVES: We examined disparities in health care use among US-Mexico border residents, with a focus on the unique binational environment of the region, to determine factors that may influence health care use in Mexico. METHODS: Data were from 2 waves of a population-based study of 1048 Latino residents of selected Texas border counties. Logistic regression models examined predictors of health insurance coverage. Results from these models were used to examine regional patterns of health care use. RESULTS: Of the respondents younger than 65 years, 60% reported no health insurance coverage. The uninsured were 7 and 3 times more likely in waves 3 and 4, respectively, to use medical care in Mexico than were the insured. Preference for medical care in Mexico was an important predictor. CONCLUSIONS: For those who were chronically ill, old, poor, or burdened by the lengthy processing of their documents by immigration authorities, the United States provided the only source of health care. For some, Mexico may lessen the burden at the individual level, but it does not lessen the aggregate burden of providing highly priced care to the region's neediest. Health disparities will continue unless policies are enacted to expand health care accessibility in the region.
Asunto(s)
Accesibilidad a los Servicios de Salud , Servicios de Salud/estadística & datos numéricos , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Cobertura del Seguro/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Comparación Transcultural , Femenino , Costos de la Atención en Salud , Servicios de Salud/economía , Servicios de Salud/normas , Accesibilidad a los Servicios de Salud/economía , Humanos , Cobertura del Seguro/clasificación , Modelos Logísticos , Masculino , Pacientes no Asegurados/etnología , Pacientes no Asegurados/estadística & datos numéricos , Medicare , Americanos Mexicanos/psicología , Americanos Mexicanos/estadística & datos numéricos , México , Persona de Mediana Edad , Motivación , Práctica Privada , Texas , Estados UnidosRESUMEN
OBJECTIVES: Compared to other groups, Mexican American women screen less frequently for cervical and breast cancer. The most significant barriers reported by previous researchers include not having a usual source of care, lacking health insurance and English-language difficulties. In this paper we document and examine the factors associated with disparities in cancer screening between border and non-border residents by language of interview (Spanish or English) among Texas Hispanic women. We hypothesize that, controlling for socioeconomic and demographic characteristics, border residents are more likely to utilize screening services than non-border residents because of the greater presence of bilingual services in border counties. DESIGN: We follow the framework of the Behavioral Model for Vulnerable Populations proposed by Gelberg et al. (Health Services Research, vol. 34, no. 6, pp. 1273-1302, 2000). This model conceptualizes use of health care as an outcome of the interplay of predisposing, enabling and need factors and recognizes that vulnerable groups face additional barriers to health care utilization. Data come from the 2000, 2002 and 2004 Texas Behavioral Risk Factor Surveillance surveys. RESULTS: Group differences in cancer screenings are explained largely by socioeconomic characteristics and structural barriers to access. The significance of language of interview and of border residence disappear after controlling for factors such as health insurance, income and a usual source of care. CONCLUSION: Women who selected to be interviewed in Spanish were less likely to report age-appropriate cancer examinations, health insurance and a regular health care provider than those who selected to be interviewed in English. Disparities in cancer screenings among vulnerable Hispanic populations could be reduced by promoting the establishment of a regular health care provider.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Mamografía/estadística & datos numéricos , Americanos Mexicanos/psicología , Aceptación de la Atención de Salud/etnología , Neoplasias del Cuello Uterino/diagnóstico , Frotis Vaginal/estadística & datos numéricos , Adulto , Factores de Edad , Sistema de Vigilancia de Factor de Riesgo Conductual , Neoplasias de la Mama/etnología , Barreras de Comunicación , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Lenguaje , Pacientes no Asegurados/etnología , Americanos Mexicanos/estadística & datos numéricos , México/etnología , Persona de Mediana Edad , Examen Físico/estadística & datos numéricos , Características de la Residencia , Factores Socioeconómicos , Texas/epidemiología , Neoplasias del Cuello Uterino/etnologíaRESUMEN
We examine twelve-year trends in the Latino uninsured population by ethnic subgroup and immigration status. From 1993 to 1999, most Latino subgroups, particularly Puerto Ricans, had large decreases in Medicaid coverage. For some subgroups these were offset by increases in employer coverage, but not for Mexicans, resulting in a four-percentage-point increase in their uninsured population. During 2000-2004, Medicaid/SCHIP expansions benefited most subgroups and mitigated smaller losses in employer coverage. However, during 1993-2004, the percentage of noncitizen Latinos lacking coverage increased by several percentage points. This was attributable to Medicaid losses during 1993-1999 and losses in employer coverage during 2000-2004.
Asunto(s)
Ayuda a Familias con Hijos Dependientes/tendencias , Hispánicos o Latinos/clasificación , Seguro de Salud/tendencias , Medicaid/tendencias , Pacientes no Asegurados/etnología , Emigración e Inmigración , Encuestas de Atención de la Salud , Humanos , Massachusetts , Pacientes no Asegurados/estadística & datos numéricos , México/etnología , Puerto Rico/etnología , Factores Socioeconómicos , Estados UnidosRESUMEN
A convenience sample of Jamaican and Haitian men completed the translated versions of the Prostate Health Questionnaire. The findings support that the translated survey is comprehensible, has internal consistency, and is reliable over time when used for these populations.
Asunto(s)
Tamizaje Masivo/métodos , Neoplasias de la Próstata/diagnóstico , Encuestas y Cuestionarios/normas , Traducción , Anciano , Actitud Frente a la Salud/etnología , Escolaridad , Emigración e Inmigración , Florida , Haití/etnología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Renta/estadística & datos numéricos , Jamaica/etnología , Masculino , Pacientes no Asegurados/etnología , Pacientes no Asegurados/estadística & datos numéricos , Hombres/educación , Hombres/psicología , Persona de Mediana Edad , Rol de la Enfermera , Investigación en Evaluación de Enfermería , Investigación Metodológica en Enfermería , Neoplasias de la Próstata/etnologíaAsunto(s)
Emigración e Inmigración , Ética Clínica , Pacientes no Asegurados/etnología , Justicia Social , Responsabilidad Social , Accidentes de Tránsito/economía , Adulto , Arizona , Costos de Hospital/ética , Humanos , Masculino , México/etnología , Justicia Social/economía , Justicia Social/ética , Atención no Remunerada/economía , Atención no Remunerada/ética , Heridas y Lesiones/economía , Heridas y Lesiones/etnología , Heridas y Lesiones/terapiaRESUMEN
In 1993, 33.8% of all nonelderly adult Hispanics living in the United States lacked health insurance coverage (either private or public), compared to 8.1% of the entire nonelderly population. Because Hispanics are more likely to be uninsured than any other ethnic group and because they are the fastest growing minority group in the United States, the increase in the Hispanic population is likely to increase the proportion of the population without health insurance. Particularly striking are differences in private health insurance coverage among the three major Hispanic groups--Cuban-Americans, Mexican-Americans, and Puerto Ricans. In this paper, regression-based decomposition analysis is used to explain the sources of differences in private health insurance coverage among working males in these three group. The results indicate that among the study population, Cuban-Americans have higher rates of private health insurance coverage than Mexican-Americans and Puerto Ricans, and that wage rates, levels of education, age, occupation, and marital status explain most of the difference.
Asunto(s)
Empleo , Hispánicos o Latinos/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Pacientes no Asegurados/etnología , Adulto , Cuba/etnología , Humanos , Masculino , Pacientes no Asegurados/estadística & datos numéricos , México/etnología , Persona de Mediana Edad , Crecimiento Demográfico , Puerto Rico/etnología , Análisis de Regresión , Factores de Riesgo , Estados UnidosRESUMEN
This paper presents trends in the growth in the US uninsured population, using cross-sectional national estimates from 1977, 1987, 1989, and 1992 and focusing specifically on coverage problems experienced by Hispanic Americans. An examination of the composition of uninsured persons added between 1977 and 1992 shows that almost 40% of the difference is accounted for by persons of Hispanic origin, with those of Mexican origin alone constituting 27%. In addition, the annual average rate of growth in the uninsured Hispanic population between 1977 and 1992 was 9.7%, compared with only 2.3% for the uninsured non-Hispanic population.