MINORITY HEALTH CARE: Opening Doors To Access
A new report offers examples of innovative, cost-effective programs that are working to reduce barriers to health care among minority and immigrant groups. The highlighted programs, ranging from a family planning program for South Florida immigrant men to a prenatal care program for homeless San Francisco women, all received support from the five-year Opening Doors initiative -- a program jointly funded by the Robert Wood Johnson Foundation and the Henry J. Kaiser Family Foundation. The report offers the general observation that sociocultural disparities exist in minority health access independent of economic status. Thomas Chapman, director of Opening Doors and president of the Washington, DC-based Hospital for Sick Children Health System, said, "Sociocultural barriers to health care are almost invisible when compared to financial barriers, yet they have undermined health care for years. Whether actual or perceived, the sense that there is a lack of respect among health care providers for patients of diverse backgrounds creates a very real obstacle between patients and providers."
Opening Doors allocated $5.5 million for 23 projects in rural and urban areas in 11 states. Innovative approaches initiated by the programs include:
- Immigrant Health: The Nuestra Decision Project, sponsored by Community Health of South Dade, Inc., "trains and deploys male farmworkers as family planning health promoters in their communities." The program has helped increase the number of immigrant women receiving prenatal care in the first trimester and the number of fathers "accompanying their partners to these visits and bringing their children" in for routine medical care.
- Prenatal Care: The Homeless Prenatal Program in San Francisco "hires and trains formerly homeless women to reach out to women living on the streets" and in shelters.
- Reproductive Health: The Alan Guttmacher Institute used Opening Doors funding to conduct a "telephone survey of low-income and minority women" ages 18-34 "to assess their attitudes and experiences in seeking reproductive health services." The survey showed that "women from all racial and ethnic groups were committed to obtaining and using contraceptives."
- Medicaid Managed Care: The Center for Reproductive Law and Policy conducted focus groups of black and Latina Medicaid managed care enrollees to assess their barriers to reproductive health care. Based on the survey, researchers determined that such barriers were attributable, in part, to "structural features in managed care," such as prior-authorization requirements, long waits for appointments, confusing handbooks and a lack of interpreters for foreign-language speakers.
Opening Doors suggests several steps providers can use to ease communication problems, such as using interpreters to increase patients' comfort level, assigning community health workers to serve "as liaisons between health care personnel and community members" and providing cultural sensitivity training to health care providers. Public agencies can also do their part by "creating funding streams to support community health care workers and interpreters," developing standards for cultural understanding of providers and "promoting community education programs to inform Medicaid recipients" about the services provided and how to access the system. Most importantly, the report urges providers to involve community leaders and organizations in research and delivery efforts. Opening Doors has launched a resource center to provide materials and other resources on sociocultural barriers and ways to overcome them. The program is also developing an interactive website, distributing a monthly compendium of hands-on information on reducing barriers to care and commissioning research on minority health care. For more information on Opening Doors, call 202/974-4694.