Improving Healthcare for Latinos March 27, 2010

1. Improving Healthcare for Latinos March 27, 2010 Michael A. Rodr�guez, MD, MPH Professor and Vice Chair of Research George F. Kneller Endowed Chair in Family Medicine UCLA Department of Family Medicine

2. Acknowledgements Network for Multicultural Research on Health and Healthcare funded by the Robert Wood Johnson Foundation

4. Geographic Location of Latinos in the US

5. Migration Patterns Among Latinos 1995-2000

6. Stats about US Latinos More than 1 in 5 children is Latino1 38% (18 million people) are immigrants2 Majority have lived in the US for more than 10 years2 66% were of Mexican origin, 9% Puerto Rican origin, 3% Cuban and 3% Salvadoran origin3

7. Latino Epidemiological Paradox 34% Lower heart disease mortality 43% Lower cancer mortality 24% Lower stroke mortality Identical low infant mortality

8. Immigrants Face many Challenges Low Socio-economic Status Living conditions Nutrition Low educational attainment Language

10. Four Areas of Unmet Health Care Needs Low quality of health care Inadequate health insurance coverage Language barriers in the US healthcare delivery system Lack of diversity among healthcare professionals

11. Low Quality of Healthcare Poorer quality of health care than non-Latino Whites on 19 of 34 measures. heart attacks, diabetes, pneumonia, htn, depression, HIV Latino children also suffer disparities shorter average visit duration, lower odds of receiving any counseling during well-child visits, less parental satisfaction, greater unmet need for mental health

12. Inadequate Health Insurance Coverage Latinos have the highest rates of being uninsured or underinsured In 2008, 32% of Latinos, 19% of African Americans, and 18% of Asians in the US lacked health insurance, compared with 10% of non-Latino Whites.

13. Coverage is particularly low among undocumented immigrants 63% lack health insurance1 Latinos 65 years and older account for 64% of all uninsured older Americans2

14. Health Insurance, Access and Health Status of Children, by Parents� Immigrant Status, 1999

15. Language Barriers Limited English proficiency (LEP) lower quality of interpersonal care lower patient satisfaction, excessive ordering of medical tests, lack of understanding of medication side effects and instructions, more frequent medical errors, decreased use of primary care, increased use of the emergency department, and inadequate follow-up. quality is compromised and more costly

16. Language Access Issues Title VI of the Civil Rights Act of 1964, mandates that all healthcare providers receiving federal funding (including Medicare or Medicaid) provide adequate language services to all patients Health care system serves nearly 16 million Latinos with LEP and 22 states have more than 100,000 residents who are LEP Spanish speakers.

17. The Centers for Medicare & Medicaid Services (CMS) allow states to include language services as an optional covered service under Medicaid and the Children�s Health Insurance Program (CHIP). Only DC and 13 states (Hawaii, Idaho, Iowa, Kansas, Maine, Minnesota, Montana, New Hampshire, Utah, Vermont, Virginia, Washington, and Wyoming) provided 3rd party reimbursement for language services through Medicaid and CHIP in 2009

18. Lack of diversity among Healthcare Professionals Minority patients are more satisfied with the health care when received from minority professionals of the same ethnicity Latinos are significantly underrepresented in the health professional workforce in all US states. Latinos account for only 3.5% of physicians, 2.0% of registered nurses

19. Healthcare Environment Supply of clinicians The clinical environment Accessibility to healthcare providers

21. Policy Priorities to Improve Access to and Quality of Health Care for Latinos

22. Two Visions of America Integration model: wants to invest in immigrants; views immigrants as a vital part of our society; recognizes economic, social and cultural contributions of immigrants to U.S. society. Marginalization model: wants to reverse the flow of immigration; creates division between immigrants and citizens, documented and undocumented immigrants, population stalls.

23. Implications of the Federal Debate on Immigration Regardless of the outcome, immigrant families will continue to represent a significant portion of our workforce, child and student population Continued investment in immigrant services will maximize contributions to the general public health, increase families� self-sufficiency, reduce SS shortfall

25. Provide Affordable Health Insurance Coverage to All US Residents

26. Enhance the Delivery of Linguistically Appropriate Care Require reimbursement for language services and enforce adherence Improve and disseminate services for interpretation

27. Diversify the Healthcare and Research Workforce Pipeline with stronger gov�t support IMG option

28. Improve Data and Systems to Define and Monitor Disparities Affecting Latinos Support recommendations 2009 IOM report on Race, Ethnicity and Language Data

29. Conclusions Severe disparities in health care Contribute to future excess morbidity or mortality, as well as increased exposure to infectious diseases and higher healthcare costs for all Need for equitable distribution of resources, including health insurance for the entire US population, Such policy efforts at the federal, regional and local health system levels will improve the quality of health care for Immigrants and all Americans

30. Thank You Michael A. Rodr�guez, MD, MPH E-mail: MRodriguez@mednet.ucla.edu