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Community-Based Health Research to Eliminate Health Disparities 2004. Elena Rios, MD, MSPH President & CEO National Hispanic Medical Association. Insurance Coverage. Hispanics have the highest rates of uninsured of racial/ethnic groups, for all or part of 2000:
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Community-Based Health Research to Eliminate Health Disparities 2004 Elena Rios, MD, MSPH President & CEO National Hispanic Medical Association
Insurance Coverage • Hispanics have the highest rates of uninsured of racial/ethnic groups, for all or part of 2000: • 50% Hispanics under age 65 • 37% Hispanic children • In 2002, comprised 14% of U.S. population, but 29% of the uninsured. • In the last decade the number of uninsured Hispanics increased from 7.4 to 12.8 million. • Less likely to have insurance, even when offered through employer. • By 2050, 25% of Americans 50% uninsured. • Source: The Commonwealth Fund, Nov. 2003
Research Needed to Address Uninsured Hispanics • 75% of uninsured Hispanics are classified as low-income (200% poverty level). • Foreign-Born Hispanics have the highest uninsured rate, declines with length of time/generations in U.S. • Legal immigrants have a 5 yr wait for public insurance • For non-elderly Hispanics, 61% of those who primarily speak Spanish are uninsured, compared to 36% of those who primarily speak English. • US-Mexico Binational Insurance products
IOM Unequal Treatment Report • Despite insurance, minority patients suffer from unequal treatment – quality care. • Recommendation: Promote research that is population-based and patient centered. • Health Disparity Legislation focus on major recommendations: increase minority health providers, cultural competence, language services, and research on Hispanic health, resources, use of care, generation, family, community.
Research Needed on Quality Care • Spanish- speaking report greatest problems communicating with doctors and staff. • Access to interpreters limited, only 1% of those used are medically trained. • Lack of cultural competence training for physicians or in medical education. • Less likely to report confidence in their doctor. • Difficulty in understanding prescription instructions. • Low representation of Hispanics as physicians (only 5% of U.S. physicians).
NHMA and CHC 2002 National Hispanic Health Leadership Summit, San Antonio, TX • Purpose: to build consensus recommendations to improve Hispanic health programs and policies at the Federal, State, private, and community levels for the next 5 years. • Partners: Congress, DHHS, RWJF, Ca Endowment, Amgen, Aventis, GSK, PhRMA, EPA, NHTSA, HSHPS, natl groups; 170 participants
Health Access • Ensure that outreach, education, and enrollment efforts are community-based and target LEP. • Develop automatic re-enrollment in highly uninsured populations. • Develop uniform financial screening tools for public programs and migrant insurance program. • Establish a web-based clearinghouse to promote research on underutilization and disenrollment of underinsured populations. • Expand Medicaid/SCHIP eligibility, including parents and pregnant women, waivers, tax breaks for employers. • Adopt universal healthcare policy.
Health Professions Training • Encourage Hispanic students to pursue health careers • Expand the HRSA Health Career Opportunity and Centers of Excellence programs, NIH career programs. • Establish partnerships with the Department of Education • Short Term: New Counseling for students on MCAT list. • Short Term: Workforce Development Research, eg. examine impact of reciprocity between U.S. and other Hispanic countries. • Long Term: Pipeline Development, • School District should establish a Health Professions Academy for Latino Students • Mentoring programs with Hispanic health professionals
Building Hispanic Community- Based Research • Increase Hispanic leadership and participation with DHHS, state/private organizations. • Build community-based research infrastructure (Empowerment Zone, Community Access Program, Reach, Exceed). • Develop and facilitate pipeline to produce more Hispanic researchers. • Develop culturally appropriate research methods – eg. the Hispanic epidemiological parodox. • Make partnerships with community organizations mandatory for funding of research on Hispanic populations.
National Hispanic Medical Association and Future Research • Established in 1994 in D.C. to improve the health of Hispanics & underserved • Journal with Amer Acad Family Physicians • 9th Annual Hispanic Health Conference, LA – 4/1-2/05 • National Hispanic health research network • National Hispanic Health Foundation - affiliated with Wagner Grad School of Public Service, NYU • Research Training on use of Hispanic health data • White Papers – “think tank” • Hispanic Health Professional Student Scholarship • www.nhmamd.org