Gulnur Scott, M.P.A. Margaret Lethbridge-Çejku, PhD Division of Health Interview Statistics

1. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Access to health care and health care utilization among Hispanic/Latino women in the United States, 2000-2002 Gulnur Scott, M.P.A. Margaret Lethbridge-Çejku, PhD Division of Health Interview Statistics

2. Background • Access to health care is an important determinant of the quality of health care, the quality and years of healthy life and the presence or absence of health disparities • Race/ethnicity is one of the key factors that contributes to disparities in health and health care utilization • Hispanic/Latinos are more likely to lack access to health care than persons of other racial and ethnic groups • The Hispanic/Latino population in the US is very diverse • Understanding differences among Hispanic/Latino subpopulations will help inform health policies and programs

3. Objectives To assess subgroup differences in access to care and health care utilization among Hispanic/Latino women by examining: • Health insurance coverage • Having a usual place of health care • Experiencing unmet medical need due to cost

4. Access to health care Health Insurance: • Insured: Covered by private or public (Medicaid, Medicare, or other public) health insurance • Uninsured: Not covered by any kind of comprehensive health insurance or health care plan – includes women with only IHS Usual source of care: • One or more places to go, other than hospital emergency room, when sick or in need of health advice Unmet medical needs: • Could not afford medical care, prescription medication, eye glasses, dental care, mental health care or counseling • Delayed care because of cost

5. Hispanic/Latino women in the National Health Interview Survey • Black and Hispanic/Latino populations over-sampled • Three data years combined to provide estimates for Hispanic/Latino subpopulations • Hispanic/Latino women in the US, ages 18 + • Hispanic/Latino subpopulations: • Mexican or Mexican-American • Puerto Rican • Cuban or Cuban American • Central or South American • Other Hispanic (Dominican Republic, Other Latin American, Other Hispanic/Latino)

6. Data analysis • SUDAAN software • Estimates weighted to reflect national estimates • Annualized sample size=3027 Hispanic/Latino women per year • Annualized weighted estimate =11,159,088 (~11% of women in US population) • Non-Hispanic black women and non-Hispanic white women used as reference populations • Three risk factors for lack of access to care investigated: poverty (as defined by US Census), lack of high school education, and family size of 6 or more members

7. Hispanic/Latino women in the U.S. Puerto Rican Mexican Cuban Central or South American Other Hispanic Data Source: National Health Interview Survey 2000-2002 Preliminary Data

8. ACCESS TO CARE AMONG US HISPANIC/LATINO WOMEN No health insurance coverage % Data Source: National Health Interview Survey 2000-2002 Preliminary Data

9. ACCESS TO CARE AMONG US HISPANIC/LATINO WOMEN No usual place of care % Data Source: National Health Interview Survey 2000-2002 Preliminary Data

10. ACCESS TO CARE AMONG US HISPANIC/LATINO WOMEN Unmet medical needs % Data Source: National Health Interview Survey 2000-2002 Preliminary Data

11. ACCESS TO CARE AMONG US HISPANIC/LATINO WOMEN Poor women without health insurance % Data Source: National Health Interview Survey 2000-2002 Preliminary Data

12. ACCESS TO CARE AMONG US HISPANIC/LATINO WOMEN Poor women with no usual place of care % Preliminary Data Data Source: National Health Interview Survey 2000-2002

13. ACCESS TO CARE AMONG US HISPANIC/LATINO WOMEN Poor women with unmet medical needs % Data Source: National Health Interview Survey 2000-2002 Preliminary Data

14. ACCESS TO CARE AMONG US HISPANIC/LATINO WOMEN Less than HS education without health insurance % Preliminary Data Data Source: National Health Interview Survey 2000-2002

15. ACCESS TO CARE AMONG US HISPANIC/LATINO WOMEN Less than HS education with no usual place of care % Data Source: National Health Interview Survey 2000-2002 Preliminary Data

16. ACCESS TO CARE AMONG US HISPANIC/LATINO WOMEN Less than HS education with unmet medical needs % Preliminary Data Data Source: National Health Interview Survey 2000-2002

17. ACCESS TO CARE AMONG US HISPANIC/LATINO WOMEN 6+ family members without health insurance % Data Source: National Health Interview Survey 2000-2002 Preliminary Data

18. ACCESS TO CARE AMONG US HISPANIC/LATINO WOMEN 6+ family members with no usual place of care % Preliminary Data Data Source: National Health Interview Survey 2000-2002

19. ACCESS TO CARE AMONG US HISPANIC/LATINO WOMEN 6+ family members with unmet medical needs % Data Source: National Health Interview Survey 2000-2002 Preliminary Data

20. Summary • 34% of Hispanic/Latino women were uninsured, 22% had no usual place of care, and 22% had unmet medical needs • Poverty, having less than a HS education, and large family size were associated with lack of health insurance and lacking a usual place of care in all women, but appear to have a greater impact on Hispanic/Latino women • Mexican and Central / South American women were disproportionately represented among Hispanic/Latino women who lacked insurance, a usual place of care, and who had unmet medical needs • 75% of Hispanic/Latino women in the US are Mexican or Central/South American; 58% are Mexican • 41% of Mexican women were poor, 50% had less than a HS education, and 19% had large families of 6 or more

21. Conclusions • Disparities in access to care and health care utilization were found among subgroups of Hispanic/Latino women in the US • Much of the disparity in access to care between Hispanic women and non-Hispanic white and black women is driven by lack of access to care among Mexican and Central and South American women in the US • Even among women who shared characteristics shown to be associated with a lack of health care access - poverty, lack of education, and large family size – a greater proportion of Mexican and Central/South American women were adversely impacted compared with other Hispanic/Latino women, and compared with non-Hispanic black and white women

22. Percentage of Hispanic/Latino and non-Hispanic women in the U.S. 2000 2001 2002 % % % Hispanic/Latino 10.7 11.0 11.3 Non-Hispanic white 76.9 76.5 76.2 Non-Hispanic black 12.4 12.5 12.5 Data Source: National Health Interview Survey 2000-2002 Preliminary Data