Study Ranks Latinos Last in Health Coverage

As the debate over health care reform takes center stage in Washington, a team of UCLA researchers has found that Latinos lack health insurance coverage more than any other ethnic group in the nation and that a significant number of Latinos would be uninsured even if proposals currently under consideration are adopted.

The study, published today in the Journal of the American Medical Assn., found that 39% of Latinos under the age of 65--or 7.2 million people--were uninsured in 1989. That rate is three times higher than the rate of uninsured Anglos and nearly twice that of uninsured blacks.

Moreover, the researchers found that because of differences in Medicaid eligibility, the large size of most families and the types of jobs many hold, Latinos may not be helped by strategies designed to increase access to medical care for the nation as a whole.

The study examined seven major health care reform proposals and found that a strategy that would cover all poor people in the United States would still leave 24.6% of Latinos uninsured; even the best-case scenario would leave 10.8% of Latinos without health insurance.

For example, the researchers found that because Latinos are more likely than any other group to work for small businesses, or to be self-employed in low-paying, low-skilled jobs, they would be less likely to receive insurance under plans that require employers to provide it. They also found that children, who make up a large proportion of the Latino population, would probably suffer under such proposals if dependents are not covered.

The findings mirror a 1991 UC Irvine study, which found that 44% of Latinos surveyed lacked health insurance.

“Latinos here clearly have the worst access to health care of any ethnic group in the county,” said Dr. Howard B. Waitzkin, a professor of internal medicine and one of the authors of the UCI report. “The situation is quite appalling. . . .”

“We found that access to health insurance and care for documented Latinos is almost as bad as access for undocumented Latinos,” added Waitzkin, who serves on the Orange County Task Force on Indigent Health. “It seems to be a phenomenon here that has to do with the same factors (the UCLA study) mentions--of insurance not being provided as a fringe benefit at companies where many Latino people work.”

Today’s JAMA article, which appears three weeks after First Lady Hillary Rodham Clinton was appointed by the President to oversee a commission on health care reform, is clearly timed to influence the public policy debate.

The study urges officials to concentrate as much on broadening access to health care as on the financial difficulties of providing the uninsured with insurance.

“No matter which strategy we undertake, Latinos may still face major health care access difficulties,” wrote Robert Valdez, a health policy analyst at the UCLA School of Public Health and the lead researcher on the project. “Thus we must look beyond simply ‘the financing’ to consider basic reform of this nation’s medical care system.”

Moreover, Valdez wrote in the article: “The Latino population deserves special consideration because it is often assumed by policy-makers that policies devised with poor black communities in mind will equally serve other poor populations. . . . Latino communities appear particularly vulnerable to the weaknesses in the current system of financing medical care.”

Experts say that several factors beyond a simple lack of insurance often preclude Latinos from seeking medical treatment and preventive care. Language barriers and cultural factors come into play; one recent study, for example, found that Latinos exhibit fatalistic attitudes toward cancer that may keep them from seeking mammograms and other preventive screening.

“There is a cultural component that needs to be addressed (in any health care reform package),” said Gary Marks, a professor of preventive medicine at USC who studies the health care practices of Latinos.

“There are very strong familial values in Hispanic cultures. . . . You just can’t offer the services. They have to be provided in a culturally sensitive fashion.”

The UCLA team took note of this problem, complaining that U.S. medical schools have not produced an adequate number of Latino physicians and that few doctors “understand the social or cultural issues” that are important to Latino medical care.

The authors also called upon policy-makers to consider establishing community-based prepaid health plans that would serve Latino neighborhoods.

In Orange County, government officials have discussed launching a managed health care program for some indigent patients by 1995, but without any infusion of new county funds, according to UCI’s Waitzkin.

“It is certainly not going to provide care for the population of Latinos we are talking about,” he said.

What is needed, according to Waitzkin and other health care experts, is greater public commitment to the health and welfare of citizens, including all ethnic groups.

“Orange County, despite its wealth, has one of the worst records of health care access of any county in the country,” Waitzkin said.

“The county has chosen to spend far less on a per-capita basis for health care than any of the 10 most populated California counties, so what happens is that there essentially is no primary health care system that is organized and accessible to the general public.”

The UCLA study analyzed Census Bureau statistics from 1980 to 1990 and looked at Latinos across the country as well as in nine states with large Latino populations, including New York, California, Texas and Florida.

In an interview, UCLA’s Valdez said Tuesday that he is especially concerned by the statistics because they indicate that Latinos would be hard-hit by any plan requiring employers to provide insurance. Such a plan might backfire, he said, forcing small companies out of business and costing a disproportionate number of Latinos their jobs.

Valdez added that he hopes that “the decision-makers in Washington and Sacramento and other places take note . . . that no matter what targeted strategy we choose, some people are likely not to do as well as others, and we have to know who they are so that we can take further steps to make sure they are not overly burdened.”

Times staff writer Kristina Lindgren contributed to this story.