regular health care provider mean less preventive care, fewer ambulatory visits, and higher rates of emergency room use compared with whites, although Hispanics’ rates of inpatient care are equivalent to those of whites. The preventive services on which Hispanics trail whites include pneumococcal and influenza vaccinations for seniors; mammography, pap smears, and colon cancer screening; blood pressure and cholesterol measurements; and prenatal care for the general population. In 2001, just 75 percent of Mexican and 79 percent of Puerto Rican women received prenatal care in their first trimester, compared with 92 percent of Cuban and 89 percent of white women. Hispanic–white differences in childhood vaccination rates are trivial.98

Evidence on the quality of care received by Hispanics is inconclusive, partly because current assessments are based on populations that are not truly representative, such as low-income Medicaid recipients, and partly because results from satisfaction surveys are inconsistent. Nonetheless, Hispanics’ reported satisfaction with health care delivery reveals large differences, depending on the degree of English proficiency. In general, Hispanics who speak only Spanish report worse experiences with health care than either whites or Hispanics who speak English. Satisfied patients are more likely to seek care when needed, to comply with provider recommendations, and to remain enrolled in health plans and with specific providers. Paradoxically, and for reasons not fully understood, Spanish-speaking Hispanics rate their physicians and health plans higher than do English-proficient Hispanics, despite admitting to worse care experiences.

To reduce language barriers to health care, the Department of Health and Human Services issued a directive in August 2000 requiring all federally funded programs and providers to offer interpreter services at no cost.99 Yet only about half of Hispanic patients who need an interpreter receive one. In most cases, the interpreter is a staff person, relative, or friend rather than a trained medical interpreter; in such cases, reported satisfaction rates remain below those of whites.

CONCLUSION

Hispanic integration experiences are as diverse as the eclectic subgroups subsumed under the panethnic identity, but some general trends are discernible. Hispanic families converge in form and function with those of the white majority and rising intermarriage blurs the boundaries of nationality groups. The rise in divorce and nonmarital childbearing over time and



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