Sick in America: Hispanics Grapple With Cost And Quality Of Care

May 31, 2012
Originally published on May 31, 2012 2:27 pm

In our recent poll on what it means to be sick in America, one ethnic group stands out as having special problems – Hispanic Americans.

The national survey, conducted by NPR with the Robert Wood Johnson Foundation and the Harvard School of Public Health, sheds new light on Hispanics' health issues. It runs counter to the widespread impression that African-Americans are worst-off when it comes to the cost and quality of health care.

Take the pocketbook issue. When we asked about the burden of out-of-pocket costs – the medical bills not covered by insurance or any government program — 42 percent of Hispanics say this is a "very serious" problem for them.

That's more than twice the proportion of non-Hispanic whites with recent illness who say so, and 8 percentage points higher than African-Americans.

Robert Blendon of Harvard, who helped design the poll, says Hispanics "are more likely to be uninsured or have insurance with big holes in it than African-Americans."

That may be, he says, because Hispanics are more likely to live in rural areas or in cities where fewer supports are available for uninsured or poorly insured people. "A lot of Hispanics work for small businesses with terrible insurance or none at all," Blendon notes.

The National Alliance for Hispanic Health says that Hispanics are more likely to lack health insurance than any other group – 31 percent are uninsured, compared to 21 percent of non-Hispanic blacks and 12 percent of non-Hispanic whites.

Other recent data show that nearly half of all Hispanics are on Medicaid or income-eligible for the program, a safety net for the poor and near-poor. That's higher than any other U.S. racial or ethnic group. (Hispanics are also highest in being eligible for Medicaid but not enrolled.)

Elderly Hispanics are also less likely than other groups to be on Medicare.

That all fits with another finding from the Sick in America poll. Among Hispanics who've been seriously ill within the past year, one in four say they weren't treated as well because of their health insurance situation. That's almost twice as many as recently sick whites.

Hispanics report more problems with the quality of their care too.

An unusual feature of the Sick in America poll is that it compared the experience and opinions of Americans who have been hospitalized within the past year or had serious illness requiring "a lot of medical care" with those without major illness.

Most polls don't separate out the sick and the well, so the problems of those with recent experience of the U.S. health care system can be masked.

It turns out thatnearlytwice as many Hispanics with recent illness (42 percent) say their care was poorly managed than sick whites (23 percent).

Hispanics are far more likely to say they had to wait for test results (32 percent) compared to whites (19 percent) or blacks (15 percent).

And Hispanics are much more likely to say they didn't get access to the latest technology (29 percent) than whites (12 percent) or blacks (13 percent).

Blendon says there's no evidence that Hispanics have higher expectations of health care than other groups, which could explain these perceptions. "My gut feeling is that they would have lower expectations," he says.

The Harvard researcher, an expert on public opinion and health care, predicts that these previously uncovered perceptions about health care among Hispanics are likely to become more visible.

"Hispanics are becoming a greater proportion of the US population and are having more influence in politics and policy," Blendon says. "So their concerns about health care are likely to be heard more widely in the future."

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Now, we'd like to switch gears and talk a little bit about staying healthy and what that means in this country. You might have had an opportunity to catch some of the stories from NPR's Sick in America series. NPR partnered with the Robert Wood Johnson Foundation and Harvard School of Public Health to interview more than 1,500 adults to find out what it's like to be sick in America and to find out whether attitudes about health care differ between people who have been sick recently and those who have not.

Now, last week, we talked about some of the challenges faced by minorities, in particular. This week, we wanted to dig further into one of those groups, Hispanic people, because the answers of Hispanic respondents really stood out on a number of questions about the cost of care and the quality of care compared to both whites and blacks.

NPR's science correspondent, Richard Knox, is back with us to tell us more about this. Welcome back. Thanks for joining us again.


MARTIN: Now, first, let me say, in our conversation last week, you talked about the fact that the survey found that, overall, people of whatever background - if they'd been sick - had a different response to the health care system than people who had not. But, even saying that, there are areas in which the answers of Hispanic respondents stood out. Can you give us an example or a couple of examples?

KNOX: Sure. Well, first of all, about this poll, it's really unusual to have a poll that does zero in on people who've had recent experience with serious illness, so that's important to keep in mind. These are people who've been in hospital in the past year or people who've had a lot of medical care in the past year.

And there were more concerns about the quality of care among Hispanics that I don't think we've appreciated very much from previous data. Contrary to the widespread perception, perhaps, that blacks are the worst off when it comes to quality of care, twice as many Hispanics almost with recent illness say that their care was poorly managed than white people who had been sick recently. Forty-two percent of Hispanics say that they had poorly managed care if they'd been sick. Twenty-three percent of whites.

MARTIN: And Hispanics are more likely to say that they had to wait for test results compared to whites or blacks. Twice as many Hispanics say they were treated poorly because they're uninsured, so I wanted to ask, what about the insurance question? Thirty-one percent of Hispanics, according to the Alliance for Hispanic Health, are uninsured. Do you think that the access to insurance is driving these answers?

KNOX: It's certainly a factor. As you say, 31 percent of Hispanics lack insurance. That's higher than any other group. It's 21 percent of blacks, 12 percent of non-Hispanic whites. Nearly half of Hispanics are eligible for Medicaid or are on Medicaid. That's higher than any other U.S. racial or ethnic group.

So, yeah. I think that we can be sure from not only our figures, but others, that that's a big problem for Hispanics and maybe bigger than many people appreciate. Among Hispanics with recent serious illness, one in four say that they weren't treated as well as they'd like because of their health insurance situation. We might call it insurance discrimination. That's almost twice as many as recently sick white people.

MARTIN: We're talking about Hispanics and health care and what it's like to be sick in America. We're joined by NPR health and science correspondent Richard Knox. He recently helped report a series of stories about this and we're digging in, particularly focusing on the responses of Hispanics because they stood out compared to whites and African-Americans in the survey.

So 42 percent of Hispanics with recent illnesses said paying medical bills out of their own pocket is a very serious problem. How were most of these respondents paying for their care?

KNOX: We don't really know. I mean, we didn't ask that kind of question of them. We were asking a whole lot of questions, though.


KNOX: You know, you can't ask everything you'd like to. But we do know that, you know - yes. As you say, 42 percent say that what they have to pay out of their own pockets for medical care is a very serious problem and that's more than twice the percentage of whites who say so and eight points higher than African-Americans who say so. And, you know, again, that's a really serious problem. You know, if they have insurance, they're more likely to work for small businesses that offer lousy coverage, so they may have big holes in their insurance coverage, which means they have more copayments. They may have a high deductible that they have to pay before they get care. You know, these are real barriers to care, even among those who are insured.

MARTIN: What about programs like Medicaid, which is a government program which pays for care for people who are lower income as opposed to Medicare, which is for seniors? But what about programs like Medicaid?

KNOX: Well, Hispanics again top the list of Americans who are either in Medicaid already or are eligible for Medicaid because they have low incomes, but aren't yet signed up and I think that is a whole other area that we didn't get out of the poll but deserves further looks. Because, you know, it looks as though more Hispanics could be on Medicaid, but aren't signed up and we have to know why that is. I mean, that probably is a whole series of things having to do with education and language barriers and other reasons why they aren't in Medicaid.

But, even apart from that, you know, a high proportion are in Medicaid. Those who are are actually among the luckier Americans who are Hispanic because, in many states, Medicaid does give them access to care. It may not be as great as people who are well-insured, but it's certainly better than people that don't have insurance.

MARTIN: What else would you like to know? Other questions that you would have liked to have been able to sort of dig more deeply into? I mean, obviously, you always have to make choices when you're conducting a survey because, you know, people get impatient. You know, they get tired of answering questions. But are there areas that you think would really be important to dig into, particularly trying to sort of factor in, you know, the state of the country's health, you know, overall?

KNOX: Yeah. Well, first of all, I think that these numbers just point to a big problem that really hasn't had a lot of attention, I think. First of all, a lot of polls haven't even asked the questions of people with recent illness, so I think it's been kind of masked because the questions typically are just of everybody, whether they've been sick or not and that kind of dilutes the response of people who've had recent contact with the system.

So this is telling us that we really need to drill deeper and find why so many Hispanics feel that they're not getting good quality care and that they're suffering really hard - you know, a lot of hardship beyond what people experience. So, you know, as the researchers always say, we need more research.

I think we need to know a lot more in fine-grained detail about not just things like, you know, did you have to wait for a test result or, you know, did you think you got high technology care?

MARTIN: Yeah. Or that you didn't get access to the latest technology. Hispanics were much more likely to say that they didn't get access to the latest technology. Twenty-nine percent of Hispanics compared to 12 percent of whites and 13 percent of blacks.

You know, Richard, before we let you go - we have about a minute left. One of the issues that we talked about in our conversation last week - and if people missed that, they can always catch up by going to and - is the whole question of the, you know, cultural - whether cultural gaps or communication gaps contribute to the overall dissatisfaction with health care? And I just wonder do you think that that could be part of it. Is it just a feeling of not understanding what's going on or cultural gaps or something like that? Do you think that's a contributing factor here?

KNOX: Oh, absolutely. I think so. I mean, when we ask overall about that lack of cultural understanding, 46 percent of Americans of all kinds said that was a problem, 30 percent of people that hadn't been recently sick. And, you know, the medical system's hard enough to navigate no matter what your culture, no matter how educated you are. A lot of people tell us that they have enormous problems sort of finding their needs being met.

You have to think that people who have, you know, other kinds of cultural issues have special reasons, special needs from the health care system that just aren't being met.

MARTIN: Richard Knox is a health and science correspondent at NPR. He was kind enough to join us from his office in Boston, Massachusetts. Richard Knox, thanks so much for speaking with us again.

KNOX: Any time, Michel. Transcript provided by NPR, Copyright NPR.