Ninth Annual Maternal and Child Health Epidemiology Conference / December 10-12, 2003
GULNUR SCOTT: By the way, she said my name correct. I usually get letters that say, "Dear, Mr. Scott." I'm Gulnur Scott. That's the way that I say it, and I will be talking about "Access to Health Care Among Hispanic Latino Children: United States, 1998-2001," and I'd like to thank my co-author, *Hannah *Neu, for her help with this project. Unfortunately, she couldn't be here today. First, I'd like to give you some background information about our research. Having access to quality health care has been found one of the most important determinants of well being of America's children. We all know that the timely and adequate medical care, such as immunizations and physical examinations can improve the health of our children. Research, however, has shown that Hispanic Latino persons are far more likely to lack access to health care than persons of other racial and ethnic groups. And very few studies have provided national estimates of access to health care by ethnic subgroups of Hispanic Latino children. So our objectives were to provide recent national estimates of access to health care for subgroups of Hispanic Latino children as well as to assess an ethnic disparity in access to health care among Hispanic Latino children.
Our data source came from the National Health Interview Survey. We combined four years of survey in order to provide more reliable estimates. The National Health Interview Survey is a nationally representative (inaudible) interview survey that has been in the field since 1957, conducted by the National Center for Health Statistics. The black and Hispanic Latino populations are now over-sampled in the HIS. Our target population was Hispanic Latino children age less than 18 years. In the HIS, a child is considered being Hispanic if the parent reported that the child's national origin was Mexican or Mexican-American, Central or South American, Puerto Rican, Cuban or Cuban-American, Dominican Republic, multiple Hispanic, and other Latin or Spanish. In the HIS, the Hispanic Latino population includes all Hispanic Latino persons regardless of race. We assessed access to health care by examining health insurance coverage, usual source of health care, and unmet medical needs due to cost. In the HIS, the respondents are first asked if they're covered by any kind of health insurance or health care plan at the time of the interview. For those respondents who say yes, then they are asked what kind of health care coverage they have based on a list including public health insurance and private health insurance. We defined lack of health insurance coverage as children who are not covered by any kind of health insurance or health care plan at the time of the interview.
We looked at different types of coverage, private and public. The public coverage includes Medicaid, Medicare, and the state children's health insurance program. Usual source of care was defined by the following two questions in the HIS: is there a sample that sample child usually goes when he or she is sick or you need advice about his or her health? And the second question was: what kind of place does sample child go to most often? We defined unmet medical needs as children who could not afford medical care, prescription medication, eyeglasses, dental care, mental health care or counseling, as well as children who delayed care because of cost. Our statistical analysis included 14,384 Hispanic Latino children. We related our data to reflect national estimates, and we also used the (inaudible) software. Of the 14,384 Hispanic Latino children, 64 percent were Mexican, nine percent were Puerto Rican, three percent were Cuban, nine percent were Central or South American, and 15 percent were Other Hispanic.
This shows place of residence among Hispanic Latino children. Forty-six point three percent of Hispanic Latino children lived in the west; 31 percent lived in the south; 14 percent lived in the northeast; and only about nine percent lived in the Midwest. Twenty-five point seven percent of Hispanic Latino children did not have health insurance coverage at the time of the interview, compared with only 7.8 percent of non-Hispanic white children. Among the subgroups, we see that Mexican children were the most likely to lack health insurance coverage compared with Puerto Rican, Cuban, Central or South American, and other Hispanic children. This shows lack of health insurance coverage by age for Hispanic and Latino children. In all age groups studied in our analysis, Mexican children were found the most likely to lack health insurance coverage in this analysis. This shows lack of health insurance coverage by poverty status among Hispanic Latino children. The dark purple is for poor children. The light purple is for near-poor children. And the gray one is for not-poor children.
Overall, Hispanic children from poor and near-poor families were more likely to lack health insurance coverage compared with non-Hispanic white children from poor or near-poor families. When we look at the subgroups, Mexican children from poor and near-poor families were the most likely to lack health insurance coverage at the time of the interview, followed by Central or South American children. This shows lack of health insurance coverage by nativity among Hispanic Latino children. The red bars show U.S.-born children, and the blue bars show foreign-born Hispanic Latino children and also non-Hispanic white children. We see that overall foreign-born Hispanic Latino children were more likely to lack health insurance coverage at the time of the interview compared with U.S.-born Hispanic Latino children. Forty percent of Hispanic Latino children had public coverage among poor and near-poor families compared with 32.9 percent of non-Hispanic white children.
We see here the Mexican children were the least likely to be covered by public coverage compared with Puerto Rican, Cuban, Central or South American, and other Hispanic children. Eighty-five point nine percent of Hispanic Latino children had the usual source of health care, compared with 95.8 percent of non-Hispanic white children. The percent of children who had a usual source of health care was lowest among Mexican children. Hispanic children from poor and near-poor families were less likely than non-Hispanic white children from poor and near-poor families to have a usual source of health care. Among the subgroups, Mexican children from poor and near-poor families were the most likely to lack a usual source of health care, compared with the other four Hispanic subgroups. Overall, foreign-born Hispanic Latino children were less likely to have a usual source of health care, compared with U.S.-born Hispanic Latino children.
This (inaudible) pie chart show usual source of care for Hispanic and non-Hispanic white children. The first one is for Hispanic children. The second one is for non-Hispanic white children. About 66 percent of Hispanic Latino children went to doctor's office as their usual source of care, compared with 83 percent of non-Hispanic white children. Thirty-one percent of Hispanic Latino children went to a clinic or a health *center care compared with only 15 percent of non-Hispanic white children. This three-part (inaudible) place of routine or preventive care for Hispanic and non-Hispanic white children, again, the first one is for Hispanic and the second one is for non-Hispanic white children. Fifty percent of Hispanic Latino children did not get routine or preventive care, compared with only 29 percent of non-Hispanic white children. Eighteen percent of Hispanic Latino children who went to doctor's office as their place of routine or preventive care, compared with 42 percent of non-Hispanic white children.
This shows all my medical needs among Hispanic Latino children. Again, Hispanic children were more likely to have unmet medical needs due to cost than non-Hispanic white children. The percent of children who had unmet medical needs was the lowest among Cuban children. Overall, foreign-born Hispanic Latino children were more likely to have unmet medical needs due to cost than U.S.-born Hispanic Latino children. This three-part chart shows length of time since last contact with a health care professional for Hispanic and non-Hispanic white children. Again, the first bar chart is for Hispanic; the second one is for non-Hispanic white children. About 67 percent of Hispanic Latino children who went to a health care professional within the six months compared with 75 percent of non-Hispanic white children. Three percent of Hispanic Latino children, however, never went to a health care professional, compared with only one percent of non-Hispanic white children.
So in summary, poor and near-poor Hispanic Latino children were more likely than poor and near-poor non-Hispanic white children to be covered by a public plan. Among poor and near-poor Hispanic Latino children, Mexican children were the least likely to be covered by a public health plan. Foreign-born Hispanic Latino children were 2.8 times as likely as U.S.-born Hispanic Latino children to lack health insurance coverage. Among the foreign-born ethnic subgroups, Mexican children were the most likely to lack health insurance coverage. Hispanic Latino children were less likely than non-Hispanic white children to have a usual place to go for medical care. The percent of children who had a usual place to go for medical care was lowest among Mexican children. The percent of children experiencing an unmet medical need due to cost was higher for foreign-born Hispanic Latino children than for U.S.-born Hispanic Latino children. In conclusion, there was an ethnic disparity in access to health care among Hispanic Latino children. Mexican children were the most likely to lack access to health care in our analysis. For more information, this is our website, where you can find reports, our questionnaires, and separate descriptions, and thank you.