Hispanics’ low incomes and occupational characteristics are associated with low rates of health insurance coverage. Lacking health insurance makes the costs of health care services prohibitive for many people and is the most important barrier to adequate health care access.

Specific features of the Hispanic population that affect their access to health care include degree of acculturation, language, and immigration status. More than two-fifths of Hispanics in the United States are foreign-born, and many are recent immigrants who retain their cultural beliefs and behaviors regarding health and health care. Most foreign-born Hispanics primarily speak Spanish, and fewer than one-fourth report speaking English very well. In 2000, only 28 percent of foreign-born Hispanics were naturalized citizens, a rate lower than the rates of naturalization for other immigrant groups. Among Hispanics who are not citizens, a sizable number are undocumented immigrants.

These features of the Hispanic population have both direct effects on reducing access to health care and indirect effects through their association with lower rates of health insurance coverage. The jobs available to recent and undocumented immigrants who lack proficiency in English are unlikely to provide health insurance as a benefit of employment. Furthermore, under recent legislation, recent immigrants and noncitizens may receive fewer benefits than earlier immigrants and citizens from public health insurance programs.

In this chapter, we review the evidence on access to health care for Hispanics and on the quality of health care that they receive. We provide a summary of the existing research and also present new data from recent national surveys. To provide a context for interpreting the data, our tabulations compare Hispanics with non-Hispanic whites and non-Hispanic blacks. We also focus on specific features that are of particular importance to Hispanics, including national origin, length of time in the United States, language, and citizenship, and we assess how these features are associated with access to and quality of health care. Our analyses of national-origin groups are constrained by data availability. Thus, of necessity, most of the analyses focus on Hispanics of Mexican, Puerto Rican, and Cuban origin, in addition to a residual category of “other” Hispanics.

ACCESS TO HEALTH CARE

Access to health care refers to the degree to which people are able to obtain appropriate care from the health care system in a timely manner. Researchers who study access to care often distinguish between “potential access,” which refers to the presence or absence of financial and nonfinancial barriers to obtaining appropriate and timely care, and “realized access,” which refers to the quantity of health care actually received.



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