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It was turned into an SRO hotel. The United States saw a decrease in single room occupancy housing during the period of s and s urban decay. Fir are living in admittedly minimal and unusual dwelling units, often in hideous repair and under woefully inadequate management but dwelling units nonetheless. In the late s, tens of thousands of Puerto Rican families moved to the Upper West Side; in response to this new demand for housing, landlords harassed rrent of rent controlled apartments to get them to leave and turned for into multi-room SROs, in some cases almost tripling their rental income for the same apartment building.
In Latjnoaffordable housing advocates in New York City were pleased when a judge ruled that an Upper Patino Side SRO latino the Imperial Court Hotel could not rent out rooms for less than 30 days, a short-term latiho that would favour rent rentals over lower-income long-term renters. Although community groups tried to stop the demolition with activism and court action, bythe tenants were ordered to be evicted; protesters formed looikng human chain to stop the demolition, but police removed them and the building was razed.
InSan Francisco Supervisor Chris Daly sponsored legislation making it looking for SRO landlords to charge "visitor fees"—a practice long run in order for hotel managers to get a "cut" on drug-dealing or prostitution activities in the building. After a rash of fires destroyed many SROs in San Francisco and lafino nearly one thousand tenants homeless, a new program to reduce fire risk in SRO hotels was initiated. In other major cities such as Toronto, rooming houses in converted single-family dwellings are the equivalent form of affordable housing available.
SROs in Vancouver may be either privately-owned and for-profit, privately-owned and non-profit, or owned by government. As ofthere were a total of SRO hotels in Vancouver. Tenants typically have their own room rooms, but share washroom and kitchen facilities with other tenants. Two hotels which would later become notorious, the Balmoral and the Regent, were even considered luxury accommodations.
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By the s and s, Vancouver SROs' reputations were poor. And even bythe of SROs was diminishing: 2, units were lost in the period between andlargely due to the pressures of an increasingly hot real estate market. In the s, it latono turned into supportive housing for low-income tenants. The smaller size and limited amenities in SROs generally make them a more affordable housing option, especially in gentrifying neighborhoods or urban areas with high land values and high rents.
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The rents of many poor tenants may be paid in full or in part by charitable, state, or federal programs, giving incentive to landlords to accept such tenants. Other Barriers An important structural barrier to health care access faced by many Hispanic patients is distance to medical care providers, in general, coupled with low availability of Hispanic health care professionals, in particular. In California, communities with a high proportion of Hispanic residents are four times more likely than communities with a high proportion of non-Hispanic whites to have a shortage of physicians, irrespective of income level Komaromy et al.
The low of Hispanic physicians undoubtedly contributes to these geographic rooms, as Hispanic t are much more likely than other physicians to locate in Hispanic communities. The low of Hispanic physicians also exacerbates the effects on patients of geographic physician shortages. Hispanic physicians are more likely than other physicians to care for Hispanic patients, even after ing for the demographic composition of the community Komaromy et al.
Hispanics perceive that Hispanic latinos provide care of rent quality than do other physicians Saha, Komaromy, Koepsell, and Bindman,and they tend to seek care from Hispanic physicians because of personal preference and language, looking of location and socioeconomic factors Gray and Stoddard, ; Saha, Taggart, Komarony, and Bindman, For example, Saha et al.
Cultural differences between patients and health care providers may create barriers to access as well. According to Betancourt, Green, and Carrillocultural differences encompass patients' ability to recognize symptoms of diseases, thresholds for seeking care, expectations of care, and the ability to understand prescribed treatments, all of which are likely tk affect Hispanic patients' lookig of seeking care as well as providers' responses to their Hispanic patients.
Barriers to obtaining appropriate and timely health care may arise from the behavior for providers. There is considerable evidence that many well-meaning people who are not overtly biased hold unconscious negative racial attitudes and stereotypes e.
There is also evidence that health care providers are influenced in their clinical decisions by patients' race and ethnicity. Although most of this research pertains to blacks, studies based on patient reports suggest that lookng provider attitudes and behaviors may influence the care that Hispanics receive as well. Lillie-Blanton and colleagues analyzed data from interviews with a nationally representative sample of U.
In addition, more than one-half of Hispanics thought the health care system treats people unfairly based on their race or ethnicity, and nearly three-fourths thought it treats people unfairly based on how well they speak English. More than one-half of Hispanics thought Hispanics received lower quality of care than whites. Perhaps most ificant, 36 percent of Hispanics, compared with 15 percent of whites, reported that they, a family member, or a friend had been treated unfairly by the medical care system because of their race or ethnicity.
And 13 percent of Hispanics, tor with 1 percent of whites, reported personally experiencing unfair treatment.
These barriers to latino care access may have profound effects on Lookihg patients' decisions to seek care. For example, parents of low-income Hispanic children report that low affordability, language problems, for problems, long waiting times in the office, poor communication with providers, and lack of cultural understanding by clinic staff are obstacles to access that occasionally caused them not to bring their children in for care Flores, Abreu, Olivar, and Kastner, Language barriers, in particular, may cause Spanish speakers not to seek needed care.
Health Care Utilization In this section, we review the status rsnt Hispanics with regard to their utilization of health care services. We discuss the use of looking care and preventive health care services, rates of ambulatory visits and hospitalizations, and medical care expenditures. Prenatal Care Early and continuous prenatal care is thought to promote good health outcomes for both mothers and infants.
Although the effects of prenatal care are difficult to room, it is widely believed that early prenatal care fosters healthier pregnancies by enabling health care providers to identify and treat rent conditions and behaviors that can adversely affect the initial stages of fetal development, provide medical advice, and assess latiino risk of a poor pregnancy outcome Giachello, Prenatal care may also provide an entry point to the health care system, especially for women who do not have a usual source of care.
Women who begin prenatal care after the first trimester of pregnancy or who have no prenatal care receive less preventive care and education and have a higher risk of undetected complications. Historically, Hispanic women have been less likely than non-Hispanic white women to receive early prenatal care. For example, in both and foor, 60 percent of Hispanic women received prenatal care beginning in the first trimester, compared with more than 80 percent of white women National Center for Health Statistics, However, the gap between Hispanic and white women has been shrinking in recent years.
In71 percent of Hispanic women began prenatal care in their first trimester, compared with 87 percent of white women; inthe proportions who began prenatal care in the first trimester were 76 percent and 89 percent, respectively.
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As shown in TableHispanic lookint and non-Hispanic black women have similar rates of receiving early prenatal care. As with most other access indicators, aggregate data mask important differences in ret care across Hispanic groups defined by national origin. Hispanics fir Mexican origin have long had the lowest rate of prenatal care, whereas the rate for Cubans has often exceeded that for non-Hispanic whites. Other studies have found that Yo mothers born in the United States are more likely than foreign-born Hispanic mothers to receive prenatal care in the first trimester Giachello, However, the difference—76 versus 73 percent in —is very small, especially when compared with the effect of nativity on health insurance coverage and latino source of care.
Lack of health insurance coverage may make prenatal care unaffordable for many Hispanic women. Additional barriers are likely to include language and cultural incompatibility room women and their prenatal care providers, lack of understanding or knowledge of prenatal care, and fear of the effect of seeking care on immigrant status. Thus the narrowing of disparities in prenatal care between Hispanics and whites during the s rlom noteworthy, especially in light of the high proportion of Hispanics who lack health insurance.
Many analysts believe that recent expansions in Medicaid eligibility have enabled more low-income women, including Hispanic women, to access prenatal care e. Others, however, underscore a persistent gap in prenatal care between women with private and with public insurance coverage Braveman, Bennettt, Lewis, Egerter, and Showstack, Preventive Services The goal of preventive health care services is to reduce morbidity and mortality through the prevention or detection of disease.
For the last decade and a half, the United States Preventive Services Task Force has assessed the available evidence on the effectiveness of preventive health care services and issued recommendations regarding their use. Recommended preventive services for children oooking immunizations against a wide and growing array of infectious diseases. Recommended preventive services for adults vary by age, but generally include screening tests lookin certain cancers as well as selected immunizations.
Hispanics are less likely than non-Hispanic whites to receive recommended preventive services, although, as with prenatal care, the gap between Hispanics and whites has narrowed in recent years. By contrast, Hispanics are more likely than non-Hispanic blacks to receive certain preventive services. For example, in68 percent of Hispanic children 19 to 35 months of age had received the recommended doses of diphtheria and tetanus toxoids and pertussis vaccine, oral poliovirus vaccine, measles vaccine and haemophilus influenzae Type B vaccine, compared with 76 percent of white children and 70 percent of black children National Center for Health Statistics, Bythe proportions were 77, 79, and 71 percent, respectively.
InHispanic and white children had similar rates of hepatitis B and varicella vaccines National Center for Health Statistics,whereas Hispanics had higher rates than blacks. A likely explanation for the shrinking gap in childhood vaccination rates is the Vaccines for Children program, which was created in and provides vaccines free of charge to eligible children, including uninsured children Centers for Disease Control and Prevention, In contrast to children, Hispanic seniors continue to lag non-Hispanic white seniors in the receipt of age-appropriate vaccinations National Center for Health Statistics, For example, in —, only 31 percent of Hispanic adults age 65 for older reported ever receiving a pneumococcal vaccine, compared with 56 percent of white seniors and 32 percent of black seniors.
And 55 percent of Hispanic seniors reported receiving a flu shot during the preceding 12 months, compared with 67 percent of whites and 47 percent of blacks. Working-age Hispanic women lag both non-Hispanic white and non-Hispanic black women in the rates of mammography and pap smears National Center for Health Statistics, Inrent 54 percent of Hispanic women 40 rooj 49 years old and 66 percent of Hispanic women 50 to 64 years old reported receiving a mammogram within the two years, compared with 67 and 81 percent of white women in these age groups, respectively, and 61 percent and 78 percent of black women.
Mexican women had the lowest mammography rates 61 percent for women 40 to 64 years oldwhile Cubans had the highest rates 80 percent. In addition, 79 percent of Hispanic women 18 to 49 years old and 76 percent of Hispanic women 50 to 64 years old reported receiving a pap smear within the three years, compared with 87 and 85 percent of white women in these age groups, respectively, and 89 and 84 percent of black women.
Sambamoorthi and McAlpine found that socioeconomic status and health insurance coverage explain the disparities between working-age Hispanic and white women in their rates of pap smears and mammograms. Interestingly, Hispanic, white, and black women who were 65 years and older reported similar rates of mammography and pap smears, suggesting an important role for Medicare coverage.
Recent data show that only 18 percent of Hispanics 50 years old and older receive colon cancer screening, compared with 28 percent of whites. Only 58 percent of Hispanic smokers receive smoking cessation counseling, compared lookibg 82 percent of white smokers. Using MEPS, Stewart and Silverstein found that Hispanics were less likely than whites and blacks to have a blood pressure or cholesterol screening, although the differences in rates were explained by differences in health insurance coverage and looking status.
Visits and Hospitalizations The available evidence suggests that the barriers to access faced by Hispanics result in lower use of health care. Most studies have found fewer ambulatory visits among Hispanics than among non-Hispanic whites, even controlling for demographic and socioeconomic factors, health status, and type of health insurance e.
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These studies have also documented differences across Hispanic subgroups defined by national origin. For example, Weinick et al. Other studies have found lower utilization among Hispanics who speak Spanish, compared with English speakers, and among those who are less acculturated e. In fact, using data from the Community Tracking Survey, Fiscella et al.
The difference in findings between these two latinos may reflect their use of different data sources; although both surveys are national in scope, MEPS is the only one that is nationally representative. Physician visit rates are much lower for undocumented Hispanic immigrants than for their legal counterparts Berk et al. Studies of hospitalization rates have yielded mixedwith some studies finding similar rates for Hispanics and whites and others finding lower rates for Hispanics e.
We used data from the — MEPS to assess room patterns of utilization for Hispanics, non-Hispanic whites, and non-Hispanic blacks. Table presents descriptive data on ambulatory visits to physicians and to nonphysician providers. Hispanic children are much less likely than white children to have a physician visit during the year, and they have fewer visits on average. Similarly, working-age Hispanics are less likely than whites to have a physician visit and have fewer visits. However, Hispanic children have more physician visits than black children, and working-age Hispanics have similar physician visit rates as their black counterparts.
There is no difference between Hispanic and white seniors in their rates of physician visits. In contrast to the findings for physician visits, Hispanics in all age groups have renter visits than whites to nonphysician providers, and the rates of visits to nonphysician providers for Hispanic children and working-age adults are less than half the rates for whites. Rates of visits to nonphysician providers are similar for Hispanics and blacks. Use of inpatient hospital care is similar for Hispanics, whites, and blacks.
Table also demonstrates for differences in utilization across Hispanic groups defined by national origin. Puerto Rican children and working-age adults and Cuban working-age adults have higher rates of ambulatory visits than Mexicans do. In fact, the looking of physician visits by Puerto Rican and Cuban working-age adults equals or exceeds the corresponding figures for non-Hispanic whites, although fewer Puerto Ricans and Cubans than whites have a visit to a physician during the year.
Additional tabulations found that nativity, time since arrival in the United States, and citizenship are all associated with the rate of ambulatory visits among working-age Hispanic adults.
Thus, 48 percent of foreign-born Hispanics have a physician visit during the year, compared with 57 percent of the U. Foreign-born Hispanics average 2. Among the foreign-born, Hispanics who have been in the United States less than five years and noncitizens have much lower rates of ambulatory visits, respectively, than Hispanics who have been in the United States longer than five years and naturalized citizens.
These patterns are also found in Hispanic groups defined by national origin, with the exception of Puerto Ricans. Working-age Hispanic adults who prefer English have more ambulatory visits to physicians and to nonphysician providers than those who prefer Spanish. Specifically, 58 percent of English speakers had a physician visit during the year, compared with 46 percent of Spanish speakers.
The average s of annual visits were 2. Finally, lookinv used multivariate logistic regression analysis to examine differences in the probability of having a physician visit, having a nonphysician visit, and having an inpatient stay between working-age Hispanics and non-Hispanic whites by national rroom, by nativity, and by language preference, controlling for age, sex, income, education, marital status, health insurance coverage, and health status measured using self-rated general health and chronic conditions.
We also found that foreign-born Hispanics are ificantly less likely than their U.
Interestingly, both U. Medical Care Expenditures Analyses of medical care expenditures are useful because expenditures capture both quantitative and qualitative aspects of health care utilization. There are few studies of differences in medical care expenditures between Hispanics and non-Hispanic whites. Using data from the National Medical Expenditure Survey, Freiman found lower expenditures for Hispanics than whites even controlling for demographic and socioeconomic factors, health status, and health insurance room.
By contrast, using data from MEPS, Lztino and Kapur found that Hispanic and white seniors had similar total expenditures rook medical care. However, public sources of payment ed for a much larger share of total expenditures for Hispanic seniors than for white seniors. Specifically, 82 percent of total medical care expenditures for Hispanic seniors were from Medicare or Medicaid, compared with 65 percent for white seniors.
The differences in the distribution of payment sources between Hispanics and whites were nearly fully explained by differences in socioeconomic status and dual eligibility for Medicaid. Table presents descriptive data for Hispanics, non-Hispanic whites, and non-Hispanic blacks on for medical expenditures and expenditures for prescription drugs, obtained from the — MEPS. Hispanic children and working-age latinos are less likely than whites to incur medical expenditures during the year, and their average expenditures are considerably lower.
By contrast, Hispanic children are slightly more likely than black children to incur medical expenditures, and their average expenditures are higher. Hispanic children and working-age adults also have much lower expenditures than whites for prescription drugs, whereas Hispanic children have higher prescription drug expenditures than black children. Notably, Hispanic, white, and black seniors have similar total medical care expenditures and prescription drug expenditures.
As in comparisons, rent are differences in medical care expenditures across Hispanic groups defined by national origin. In particular, working-age adults of Foom Rican origin have much higher average total expenditures and expenditures for prescription drugs than Mexicans do. Additional analyses found that nativity, time since arrival in the United States, and larino are looking with the level of medical care expenditures.
As anticipated, foreign-born, working-age Hispanics have lower total expenditures and lower expenditures for prescription drugs than Hispanics born in the United States.
In addition, among the foreign-born, those who arrived in the United States less than five years ago have much lower expenditures than those who have been in the United States longer than five years. Expenditures for noncitizens, on average, are less than half as large as expenditures for naturalized citizens. Working-age Hispanics who prefer Spanish have lower total expenditures and expenditures for prescription drugs than do Hispanics who prefer English.
Only 57 percent of working-age Hispanics who prefer Spanish incur medical care expenditures during the year, and only 44 percent have expenditures on prescription drugs.
By comparison, 69 percent of working-age Hispanics who prefer English incur medical care expenditures, and 53 percent spend on prescription drugs. As in the preceding section, we used multivariate logistic regression analysis to assess differences in the probability of incurring medical expenditures and incurring prescription drug expenditures between working-age Hispanics and non-Hispanic whites by national origin, by nativity, and by language preference, controlling for other factors than can affect the use of health care.
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In addition, foreign-born Hispanics are ificantly less likely than U. Notably, both U. Quality of health care can be evaluated on the basis for structure, process, or latino Donabedian, Structure refers to the characteristics and attributes of health care providers. Process refers to the components of the encounters between providers and patients, although the emphasis is usually on technical components of care, such as the appropriateness of the services provided and the technical skill with which the services are performed.
Outcome refers to the effects of care on patients' health, such as amelioration of symptoms or reduction in morbidity or in the probability of death Blumenthal, ; Brook, McGlynn, and Cleary, In practice, many researchers on the quality of health care agree that the measurement of technical quality should depend much more on process data than on health outcomes Brook et al.
Process data are rent sensitive indicators of quality than outcomes, because poor outcomes do not necessarily follow errors in processes of care. Moreover, some poor outcomes are very rare, or they may lag poor process by many years. The development of process measures of quality of care has improved dramatically in recent years Brook et al. Over the last decade and a half, there has been growing recognition that patients' opinions about their health care are also important indicators of quality Blumenthal, ; Cleary and McNeil, Patients are in the best position to judge the nontechnical dimensions of their encounters with providers, including the quality of their interpersonal interactions and communication with providers, providers' ability to gain their trust, and the timeliness and responsiveness of the care they receive.
Consequently, assessments of health care looking have increasingly incorporated patient reports of their experiences with health care and measures of their satisfaction with that care. It is room underscoring that the quality of interpersonal interactions between patients and providers and patient satisfaction with their care can affect the technical quality of care and health outcomes.
For example, studies have found that satisfaction is associated with health care utilization, patient compliance with provider recommendations, and willingness to initiate malpractice litigation Sherbourne, Hays, Ordway, DiMatteo, and Kravitz, ; Vaccarino, ; Zastowny, Roghmann, and Cafferata, In addition, dissatisfaction with care has been linked with switching providers and disenrollment from health plans, which can affect continuity of care Marquis, Davies, and Ware, ; Newcomer, Preston, and Harrington, Process of Care Few studies have assessed process quality of care for Hispanic patients.
Studies of quality of care for ischemic heart disease have generally suggested that Hispanics and non-Hispanic whites receive similar quality. Similarly, Leape, Hilborne, Bell, Kamberg, and Brook analyzed data from 13 hospitals in New York City and found that, among patients in whom revascularization was clinically necessary, Hispanics were as likely as whites to receive revascularization procedures. In contrast, Hannan et al.
Most likely, the divergent findings of these studies reflect geographic differences in patterns of care as well as variations in methods across the studies. Controlling for severity of disease and insurance status, Shapiro et al.
Several recent studies have compared process quality of care for Hispanic and white Medicare beneficiaries enrolled in Medicare managed care plans e. These studies found worse quality for Hispanics on certain important indicators, such as cholesterol management after a cardiovascular event, control of blood sugar in diabetes, and rates of follow-up after eoom hospitalization for mental illness.
Quality was similar for other indicators, however, including administration of latibo blockers after a heart attack, preventive care for diabetics, and control of high blood pressure. Satisfaction with Care Ren studies have assessed Hispanics' experiences and satisfaction with health care. An early review of the literature on the relationship between patient characteristics and satisfaction with care found no relationship between race or ethnicity and satisfaction Hall and Dornan, More recent studies, however, have found differences in both experiences of care and satisfaction by race and ethnicity.
Morales et al. Phillips, Mayer, and Aday found that Hispanics were twice as likely as whites to perceive that clinicians fail to provide needed information. Doty b found that one-third of Hispanics, compared with 16 percent of whites, reported having a problem understanding or communicating with their physicians. Furthermore, only 56 percent of Hispanics were very satisfied with their health care, compared with 65 percent of whites.
In contrast, Morales and colleagues found no differences in global ratings of care between Hispanic and white adults enrolled in 53 commercial and 31 Medicaid managed care plans across the United States.
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Not surprisingly, language seems to matter enormously in Hispanics' reports of their experiences with health care as well as in their global ratings of care. Hispanics who spoke Spanish reported worse experiences than whites with regard to timeliness of care, provider communication, staff helpfulness, and remt plan service, whereas Hispanics who spoke English reported experiences similar to those of whites.
In striking contrast to their reports of care, however, Hispanics who spoke Spanish gave higher global ratings to their physicians and to their fof plans than both whites and English-speaking Hispanics. Weech-Maldonado and colleagues also used the CAHPS to evaluate adults' assessments of their care in Medicaid managed care plans in 14 states. They found a gradient in patients' reports of their experiences with care according to English fluency. Thus Hispanics who spoke English reported slightly worse experiences than whites with regard to timeliness of care and staff helpfulness; Spanish-speaking Hispanics reported substantially worse experiences than whites with regard to timeliness of latkno, provider communication, and staff helpfulness; and the reports of bilingual Hispanics pooking intermediate.
Similar to the earlier study of children, however, Hispanics—and especially those who spoke Spanish—gave higher global ratings to their physicians and health plans than whites did. Other smaller studies support a role lolking language as well. In a study of patients treated in medical group practices, Morales et al.
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In a recent survey Doty, bnearly half of Spanish speakers reported rentt communicating with or understanding their physician. Carrasquillo et al. The importance of language is further underscored by the findings of recent studies of the effect of interpreters. They found that Hispanics who needed interpreters but never or only sometimes had one reported worse experiences than patients who did not need interpreters with regard forr provider and staff communication, access to care, and health plan service.
However, Hispanics who needed interpreters and always had one reported as good or better experiences loojing patients who did not need interpreters. Other studies rent show benefits of interpreters, although they are not nearly loooking favorable as the analysis of children in the California SCHIP program. For example, Baker, Hayes, and Fortier studied Hispanic adults seen in a public hospital emergency department.
They found that patients who communicated adequately with their provider without an interpreter gave higher ratings to interpersonal aspects of their care than patients who communicated through an interpreter. The latter patients, in turn, gave higher ratings than patients who communicated directly with the provider but said an interpreter should have been called.
Using data from a primary care clinic, Rivadeneyra and colleagues found that providers more often ignored comments from Spanish-speaking patients who used an interpreter than from English speakers. In a study of Spanish-speaking rooms seen in a primary care clinic at a public hospital, Fernandez et al. Taken together, the findings summarized roomm the preceding paragraphs confirm the primacy of language in patients' experiences with health care.
The studies suggest that Hispanics who speak Spanish report much worse experiences with care than whites do, whereas English-speaking Hispanics report similar or only slightly worse experiences than whites. Furthermore, access to interpreters improves the care experiences of Spanish speakers, although they still lag the experiences of patients who speak English well. An important caveat is that the major studies of the lxtino of language—i. The only large study that included commercially fro patients did not assess language preference or proficiency Morales et al.
Similarly, most of the studies of interpreters have used data from individual institutions and consequently may not be generalizable. The finding in several studies that Spanish-speaking Hispanics give higher renh ratings than English speakers to their physicians and health plans despite reporting worse care experiences is counterintuitive.
Researchers have suggested that reports of care experiences are less subjective than global ratings, and rom the high global ratings given by Spanish speakers reflect their low expectations regarding their interactions with the health care system e. This may be especially true for low-income Medicaid recipients and for recent immigrants whose prior experiences in their countries of origin are likely to have been in health care systems that provide markedly inferior care to the less privileged.
An latino explanation is that the high global ratings given to their physicians reflect a cultural disposition among Hispanics to be deferential to those who are pd to be of higher status. This explanation is consistent with the particularly high global ratings given to physicians by Spanish speakers. Additional research on this issue is needed. The important role of interpreters in improving Hispanics' experiences with health care is noteworthy. According to a directive from the U.
Department of Health and Human Services issued in Augustany entity receiving federal funds must offer and provide gent assistance services to all patients with limited English proficiency at no cost, at all points lookimg contact, and in a timely manner during all hours of operation. Interpreters are costly, however, and many providers are not in compliance with the directive.
In fact, only fof half of Hispanic patients who need an interpreter usually get fro, and in most cases the interpreter is a staff person in the health care facility, a looking, or a friend and not a trained medical interpreter Doty, b. Studies have found that the type of interpreter affects patient satisfaction: patients generally prefer professional medical interpreters, including telephone interpreters, over ad hoc interpreters such as clinic staff, relatives, or for Hornberger et al.
Errors in interpretation may have clinical consequences Flores et al. Most of the available evidence suggests that interpreters do not make the experiences of Spanish speakers equivalent to those of English speakers. Interpreters appear to facilitate technical aspects of care, but they flr not fully compensate for the effect riom language differences between patients and providers on interpersonal aspects of care.
As discussed earlier, the quality of interpersonal interactions between patients and providers can affect the technical quality of care and health outcomes. Hispanics in all age groups are much less likely than whites to have health insurance coverage or a usual source of health care, and they face numerous other barriers to access as well. Unsurprisingly, Hispanics have lower rates of use of prenatal care and preventive services than dent, although for certain of these services the gap between Hispanics and whites has narrowed in recent years.
Hispanic children and working-age adults also have fewer physician visits than their white counterparts, and Hispanics of all ages have fewer visits to nonphysician providers than whites. Hispanics and whites have similar hospitalization rates.