US: Regional, language differences aff ect Hispanics ’ health-care experiences

Harold Schiffman hfsclpp at
Wed Oct 10 13:25:55 UTC 2007

Regional, language differences affect Hispanics' health-care experiences

Tuesday, October 9, 2007.GAINESVILLE, Fla. —

Hispanics face multiple barriers to health care, but their experiences
in the health-care system can vary widely by language and geographical
area, according to a new University of Florida study. In the study of
Hispanics enrolled in Medicare-managed care programs, Spanish-speaking
patients reported more negative experiences with care than did
English-speaking Hispanic patients. However, Spanish speakers in
Florida were more satisfied with their health-care experiences than
their peers in California and the New York/New Jersey region — a
finding that could be attributed to the "Miami effect." The results
appear in the October issue of the journal Health Services Research.

"Eighty-six percent of the Spanish-speaking survey respondents from
Florida live in the Miami area, the U.S. city with the highest
proportion of Hispanic residents," said lead investigator Robert
Weech-Maldonado, an associate professor in the department of health
services research, management and policy at the UF College of Public
Health and Health Professions. "Spanish is one of the primary
languages in Miami and there is an excellent network of
Spanish-speaking health providers." The study is the first to examine
health-care experiences of Hispanics — a population vulnerable to
health disparities — by regional and language differences.

The Medicare-managed care program, known as Medicare Advantage, was
designed to give beneficiaries the option of enrolling in a variety of
private plans, including health maintenance organizations, or HMOs,
and preferred provider organizations, or PPOs. Patients' out-of-pocket
costs associated with the Medicare Advantage plans are relatively
lower than those associated with traditional Medicare. Although most
Medicare recipients use the traditional fee-for-service program, about
5 million Medicare beneficiaries were enrolled in the managed care
program in 2004, according to the Kaiser Family Foundation. More than
50 percent of enrollees were Hispanic.

UF researchers analyzed data from the Consumer Assessments of
Healthcare Providers and Systems Medicare managed care survey,
conducted in 2002. The survey focused on five aspects of care:
timeliness of care, provider communication, office staff helpfulness,
getting needed care and health plan customer service. Of the more than
125,000 Medicare-managed care recipients who completed the survey, 7
percent, or 8,463, identified themselves as Hispanic. The survey was
available in English and Spanish.

Hispanic English speakers reported more negative experiences than
whites for all aspects of care except provider communication. Hispanic
Spanish speakers had more negative experiences than whites with
timeliness of care, office staff helpfulness and provider
communication, suggesting language barriers in the clinical setting.
However, the researchers were surprised to find that Hispanic Spanish
speakers reported more positive experiences with getting needed care
than their English-speaking counterparts.

"This was an unexpected result; we haven't found this in other
studies," Weech-Maldonado said. "We speculate that Spanish-speaking
Hispanics, who may be less acculturated, could be more tolerant of the
managed care practices because they are less familiar with the U.S.
health-care system."Overall, the UF study demonstrates that
differences in Hispanics' health-care experiences exist and there is
room for improvement, especially given the regional differences,
Weech-Maldonado said.

"Our study suggests that managed care companies should implement
quality improvement programs to reduce disparities in patient
experiences with care, and one area they can target is interpreter
services," he said, adding that the Hispanic Spanish speakers in the
survey were more likely than English speakers to rate their health as
fair or poor. "Managed care health plans cover a well-diversified
population, so it is important for them to look at disparities in

The UF study provides important information for legislators and
policymakers, said Dr. Olveen Carrasquillo, director of the Columbia
University Center of the Health of Urban Minorities and co-founder of
Latinos for National Health Insurance. "This study will serve as a
wake-up call to those minority organizations that have been strong
advocates of these Medicare Advantage plans," Carrasquillo said. "The
analysis by Dr. Weech-Maldonado and colleagues shows that even with
the extra payments these Medicare Advantage plans receive, large
disparities between Latinos and non-Hispanic whites exist. On many
measures, the extra money these plans are getting is not providing
added value to Latinos in many parts of the country."

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