By Madeline Torres
Halfway through fourth year of medical school, my mother became acutely ill and was eventually diagnosed with a chronic condition. She was initially hesitant to seek medical care, attributing her symptoms to longer work hours leading to a delay in her diagnosis. Many times I wondered why she delayed seeking medical care, finally concluding that my mother had fallen victim to the common barriers many Hispanics face when accessing healthcare. These barriers include lack of health insurance, immigration status, language and cultural barriers to name a few.
Let’s talk about lack of health insurance. In 2015, the Census Bureau revealed that only 47% of Hispanics reported having private insurance. In 2014, the Pew Hispanic Center reported 25% of Hispanics lacked health insurance that is nearly double compared to the 14% reported by the general population. When we break this number down by immigration status, 60% of undocumented Hispanics reported having no health insurance while 28% of documented Hispanics reported no health insurance according to the 2007 Pew Hispanic Center Survey. The reasons for lack of health insurance among Hispanics are complex, in 2000 Monheit and Vistness1 found that 42% of non-elderly Hispanics had employer-provided insurance compared to the 71% of their non-elderly white counterparts. Similarly, 56% of Hispanic male workers were offered health insurance compared to 62% of their male counterparts. Hispanics are also more common to have jobs in small firms, seasonal jobs and part time all of which have less probability of offering health insurance. The Commonwealth Fund released the findings of focus groups that listed cost of insurance and concern over immigration status as primary reasons for not obtaining coverage.
Immigration status is also a barrier to seeking services and obtaining health insurance coverage. It limits access and discourages seeking services. Public health assistance programs for low-income families such as Medicaid and the State Children’s Health Insurance Program (SCHIP) are not available to undocumented families. Furthermore, those same programs are often times unavailable to newly naturalized families or may jeopardize their ability to apply for citizenship2.
Language also plays a major component in access to healthcare. I can remember watching countless times when my mother did not understand the question being asked and the provider struggle to understand her answer. Some Hispanic patients are not fluent in English or would be more comfortable discussing health issues in their primary language. Many fear discrimination because of their accent. The inability to communicate well with their doctor also prevents patients from understanding health care information.
Lastly, Cultural beliefs contribute to the how, when, and where Hispanic seek medical care. Growing up in El Salvador, I recall eating fresh Papaya for breakfast to prevent and even treat GI worms. Even after immigrating to the U.S. my mother would seek home remedies for common ailments such as using oregano for stomachaches and chamomile tea for menstrual cramps. Depression, anxiety and other mental health problems are rarely mentioned due to the associated taboo with mental illness.
By now, you may be wondering what you can do to help facilitate the care of your Hispanic or other minority patients. I encourage you to be cognizant of cost when dealing with this and any patient population. Many patients cannot afford testing and/or imaging. Ask yourself, “How will this test change my management?” In addition, look for ways to minimize prescription drug cost: prescribe generics-NPH insulin is cheaper than brand-name insulin, for example. If you suspect there may be a language barrier, ask your patient if they would like a translator, most hospitals have translator phone services available free of cost to the patient. Provide them with information in their preferred language and ensure they are able to read. Lastly, engage patients in their care. Ask if they would agree to take a prescription medication, don’t assume that prescribing ensures compliance and provide safe alternatives when possible.
1. Monheit AC, Vistnes JP. Race/ethnicity and health insurance status: 1987 and 1996. Medical Care Research and Review. 2000;57(Suppl 1):11–35.
2. Escarce JJ, Kapur K. Access to and Quality of Health Care. In: National Research Council (US) Panel on Hispanics in the United States; Tienda M, Mitchell F, editors. Hispanics and the Future of America. Washington (DC): National Academies Press (US); 2006. 10
Madeline B. Torres, M.D. is a general surgery resident at the Penn State Milton S. Hershey Medical Center in Hershey, PA. She will start a research fellowship in surgical oncology the National Cancer Institute (NCI) this summer.
Dr. Torres was born and raised in El Salvador and immigrated to the United States with her mother and brother at the age of nine. She then went on to obtain her B.S. in chemistry from the University of Colorado at Denver and earned her MD from the University of Utah School of Medicine. She became involved with AWS during medical school after working with AWS members Amalia Cochran M.D. and Leigh Neumayer M.D. whom she considers mentors.
Her interests include surgical education, surgical oncology, work-life balance and encouraging women and minorities to pursue surgery and other careers in medicine.
Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.