Regional, language differences affect Hispanics' health-care experiences

October 9, 2007

GAINESVILLE, Fla. — Hispanics face multiple barriers to health care, but their experiences in the health-care system can vary widely by language and geographical area, according to a new University of Florida study.

In the study of Hispanics enrolled in Medicare-managed care programs, Spanish-speaking patients reported more negative experiences with care than did English-speaking Hispanic patients. However, Spanish speakers in Florida were more satisfied with their health-care experiences than their peers in California and the New York/New Jersey region — a finding that could be attributed to the “Miami effect.” The results appear in the October issue of the journal Health Services Research.

“Eighty-six percent of the Spanish-speaking survey respondents from Florida live in the Miami area, the U.S. city with the highest proportion of Hispanic residents,” said lead investigator Robert Weech-Maldonado, an associate professor in the department of health services research, management and policy at the UF College of Public Health and Health Professions. “Spanish is one of the primary languages in Miami and there is an excellent network of Spanish-speaking health providers.”

The study is the first to examine health-care experiences of Hispanics — a population vulnerable to health disparities — by regional and language differences.

The Medicare-managed care program, known as Medicare Advantage, was designed to give beneficiaries the option of enrolling in a variety of private plans, including health maintenance organizations, or HMOs, and preferred provider organizations, or PPOs. Patients’ out-of-pocket costs associated with the Medicare Advantage plans are relatively lower than those associated with traditional Medicare. Although most Medicare recipients use the traditional fee-for-service program, about 5 million Medicare beneficiaries were enrolled in the managed care program in 2004, according to the Kaiser Family Foundation. More than 50 percent of enrollees were Hispanic.

UF researchers analyzed data from the Consumer Assessments of Healthcare Providers and Systems Medicare managed care survey, conducted in 2002. The survey focused on five aspects of care: timeliness of care, provider communication, office staff helpfulness, getting needed care and health plan customer service. Of the more than 125,000 Medicare-managed care recipients who completed the survey, 7 percent, or 8,463, identified themselves as Hispanic. The survey was available in English and Spanish.

Hispanic English speakers reported more negative experiences than whites for all aspects of care except provider communication. Hispanic Spanish speakers had more negative experiences than whites with timeliness of care, office staff helpfulness and provider communication, suggesting language barriers in the clinical setting.

However, the researchers were surprised to find that Hispanic Spanish speakers reported more positive experiences with getting needed care than their English-speaking counterparts.

“This was an unexpected result; we haven’t found this in other studies,” Weech-Maldonado said. “We speculate that Spanish-speaking Hispanics, who may be less acculturated, could be more tolerant of the managed care practices because they are less familiar with the U.S. health-care system.”

Overall, the UF study demonstrates that differences in Hispanics’ health-care experiences exist and there is room for improvement, especially given the regional differences, Weech-Maldonado said.

“Our study suggests that managed care companies should implement quality improvement programs to reduce disparities in patient experiences with care, and one area they can target is interpreter services,” he said, adding that the Hispanic Spanish speakers in the survey were more likely than English speakers to rate their health as fair or poor. “Managed care health plans cover a well-diversified population, so it is important for them to look at disparities in care.”

The UF study provides important information for legislators and policymakers, said Dr. Olveen Carrasquillo, director of the Columbia University Center of the Health of Urban Minorities and co-founder of Latinos for National Health Insurance.

“This study will serve as a wake-up call to those minority organizations that have been strong advocates of these Medicare Advantage plans,” Carrasquillo said. “The analysis by Dr. Weech-Maldonado and colleagues shows that even with the extra payments these Medicare Advantage plans receive, large disparities between Latinos and non-Hispanic whites exist. On many measures, the extra money these plans are getting is not providing added value to Latinos in many parts of the country.”