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A likely explanation for the shrinking gap in childhood vaccination rates is the Vaccines for Children program, which was created in and provides vaccines free of charge to eligible children, including uninsured children Centers for Disease Control and Prevention, American Journal of Public Health. Journal of General Internal Medicine.

Several recent studies have compared process quality of care for Hispanic and white Medicare beneficiaries sspanish in Medicare managed care plans e. By contrast, Hispanics are more likely than non-Hispanic blacks to receive certain preventive services. Not surprisingly, the provision of information and services in patients' preferred language, including patient access to qualified, professional interpreters, assumes a central role in several of the standards U.

According to Betancourt et al. Our analyses of national-origin groups are constrained by data availability. As anticipated, foreign-born, working-age Hispanics have lower total expenditures and lower expenditures for prescription drugs than Hispanics born in the United States.

As discussed earlier, the quality of interpersonal interactions between patients and providers can affect the technical quality of care and health outcomes. Having a usual source of care reduces barriers to care that may arise from the difficulty and cost of searching for a health care provider. In contrast, Morales and colleagues found no differences in global ratings of care between Hispanic and white adults enrolled in 53 commercial and 31 Medicaid managed care plans across the United States.

The low of Hispanic physicians also exacerbates the effects on patients of geographic physician shortages.

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Thus Hispanics who spoke English seekin slightly worse experiences than whites with regard to timeliness of care and staff helpfulness; Spanish-speaking Hispanics reported substantially worse experiences than whites with regard to timeliness of care, provider communication, and staff helpfulness; and the reports of bilingual Hispanics were intermediate. Part 1: Quality of care—what is it?

Not surprisingly, language seems to matter enormously in Hispanics' reports of their experiences with health care as well as in their global ratings of care. Interestingly, Hispanic, white, and black women who were 65 years and older reported similar rates of mammography and pap smears, suggesting an important role for Medicare coverage.

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An alternative explanation is that the high global ratings given to their physicians reflect a cultural disposition among Hispanics to be deferential to those who are pd to be of higher status. The differences in the distribution of payment sources between Hispanics and whites were nearly fully explained by differences in socioeconomic status and dual eligibility for Medicaid. Physician visit rates are much lower for undocumented Hispanic immigrants than for their legal counterparts Berk et al.

There are few studies of differences in medical care expenditures between Hispanics and non-Hispanic whites.

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Seeknig PRWORA changed eligibility only for immigrants who entered the United States afterobservers attribute this decline in Medicaid participation to effects on immigrants who arrived before and were still eligible. In contrast to children, Hispanic seniors continue to lag non-Hispanic white seniors in the receipt of age-appropriate vaccinations National Center for Health Statistics, Errors in interpretation may have clinical consequences Flores et al. The apparent success of Medicaid eligibility expansions in increasing low-income women's use of prenatal care and of the Vaccines for Children program in reducing disparities in childhood vaccination rates demonstrates the potential of public programs and public—private partnerships to enhance uninsured people's access to essential health care services.

Hispanic male and female workers were less likely than their white counterparts to be seekihg health insurance by their employers 56 versus 81 percent or males and 62 versus 75 percent for females. Infor example, 23 percent of Hispanics lived in poverty, compared with 8 percent of non-Hispanic whites, and 56 percent of Hispanic adults age 25 or older had a high school diploma, compared with 88 percent of non-Hispanic white adults.

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In this chapter, we review the evidence on access to health care for Hispanics and on the quality of health care that they receive. Journal of the American Medical Association. Given current trends in employer-sponsored health insurance, it seems inevitable that the and proportion of uninsured Hispanics will grow rapidly in the next few years.

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An early review of the literature on the relationship between patient characteristics and somenoe with care found no relationship between race or ethnicity and satisfaction Hall and Dornan, Among workers, rates of employer-provided insurance coverage were 48 and 77 percent for Hispanic and white males, respectively, and 61 and 80 percent for Hispanic and white women. This is especially the case for immigrants who are not naturalized citizens.

Low-income people are less able to afford the out-of-pocket costs of care, even if they have health insurance coverage. For the last decade and a half, the United States S;eaks Services Task Force has assessed the available evidence on the effectiveness of preventive health care services and issued recommendations regarding their use. Overall, Hispanic working-age adults who prefer Spanish are nearly twice as likely to lack a usual source of care than those who prefer English.

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Outcome refers to the effects of care on patients' health, such as amelioration of symptoms or reduction in morbidity or in the probability of death Blumenthal, ; Brook, McGlynn, and Cleary, For example, Weinick et al. Most foreign-born Hispanics primarily speak Spanish, and fewer than one-fourth report speaking English very well.

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Furthermore, access to interpreters improves the care experiences of Spanish speakers, although they still lag the experiences of patients who speak English well. Monheit and Vistnes also used multivariate regression analysis and decomposition techniques to examine the causes of low rates of employer-provided insurance among Hispanics. For example, studies have found that satisfaction is associated with health care utilization, patient compliance with provider recommendations, and willingness to initiate malpractice litigation Sherbourne, Hays, Ordway, DiMatteo, and Kravitz, ; Vaccarino, ; Zastowny, Roghmann, and Cafferata, For Puerto Ricans, by contrast, language preference is unassociated with having a usual source of care, although Puerto Ricans who prefer English are more likely than those who prefer Spanish to have a physician's office as their usual source.

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These features of the Hispanic population have both direct effects on reducing access to health care and indirect effects through their association with lower rates of health insurance coverage.