ACCESS: Studies Examine Immigration, Minority Health

      The United States should restrict legal immigration to stem the growing tide of uninsured individuals, according to a new report by the Center for Immigration Studies. Immigrants and their children comprise 59% of the growth in the uninsured population since 1993, the study asserts, adding that the uninsured population could grow by three or four million over the next ten years if immigration rates remain unchecked. Currently, immigrants and their children, most residing in the United States legally, comprise more than 25% of the nation's uninsured. In addition, the report found that 26% of the nation's uninsured live in households headed by an immigrant. Further, immigrants in households earning more than $75,000 annually tend to have lower rates of health coverage than their native-born counterparts. Another study, funded by the Robert Wood Johnson Foundation and published in the July/August issue of Health Affairs, disputes that immigrants are contributing to the rising ranks of the uninsured, maintaining that legal immigrants "use fewer medical services than the general population." The study also concludes that most immigrants come to the United States for jobs or to live with family members, not because of government health programs. The study notes that "restricting illegal immigrants already in the United States from government health care programs is not likely to reduce the level of immigration" (Appleby, USA Today, 7/18). The full text of the Robert Wood Johnson Foundation-funded study in Health Affairs is available at http://www.projhope.org/HA/julaug00/Berk.pdf.

Barriers to Care
      Another study in Health Affairs found that while managed care enrollees face barriers to health care, such obstructions are simply different from -- not greater than -- those faced by non-managed care patients. Study co-author Kathryn Phillips, associate professor of health economics and health services research at the University of California-San Francisco, said, "There's a popular belief that managed care has all of these barriers and people are unhappy, but we found that people in both managed care and non-managed care plans face barriers. ... [W]e need to move beyond just examining managed care versus non-managed care and get into the black box to understand what the characteristics of different plans are that affect use of care and outcomes." Using data from the 1996 Medical Expenditure Panel Survey that includes responses from more than 22,000 individuals and 9,000 families, researchers also examined health care access by racial/ethnic breakdown, determining that a "substantial percentage" of those in four racial/ethnic groups studied (Hispanics, African Americans, Asian Americans and non-Hispanic whites) reported barriers to care. Overall, 16% of families reported experiencing at least one barrier to care. Compared to other racial and ethnic groups, Hispanics more frequently reported barriers such as difficulty obtaining care, going without necessary care and not being assured that family members could get necessary care. Hispanics were also twice as likely as non-Hispanic whites to experience long waits for care or have trouble communicating with their care providers. Researchers linked lack of insurance to care barriers for Hispanic families, noting that 68% who reported care barriers lacked insurance. But insurance alone was not a predictor of good access to care: The study found that "except for Hispanics, two-thirds of families with barriers to care were insured." The report authors concluded, "Increased access to insurance may reduce some of the barriers to care; however, efforts to improve access to care must address the barriers faced by insured persons as well." For the full report, go to http://www.projhope.org/HA/julaug00/Phillips.pdf.

Minority Patients Pick Minority Doctors
     In a separate Health Affairs study, researchers found that about 25% of African Americans and Hispanics who have "racially comparable physicians" said that they "explicitly considered race or ethnicity" when selecting a doctor. Patients in the study primarily cited "personal preference and language" as the reason for selecting a doctor based on race or ethnicity, though researchers noted that "racial pairing" also stems from the fact that minority doctors more often locate in predominantly black or Hispanic communities. Researchers reported that black and Hispanic physicians comprise 4%-5% of the "physician pool," but care for 25% of black and 23% of Hispanic patients. As the U.S. minority population is expected to grow in the next few years, building a "physician workforce that mirrors this diversity will require roughly doubling the number of blacks and Hispanics ... entering medical training," the report notes (Health Affairs release, 7/17). For the full report, go to http://www.projhope.org/HA/julaug00/Saha.pdf.