Proyecto ELEVAR: Evaluating the Latinx Experience With the Health Care System Through Variables on Access and Resources

Abstract

QUESTION ASKED: What is the Hispanic/Latinx experience with the health care system, particularly focusing on the role of the Affordable Care Act (ACA), and how can an increased awareness of potential barriers guide clinical practice, recommendations, and interventions to improve patient satisfaction and overall outcomes, particularly in those affected by cancer? SUMMARY ANSWER: Despite an increase in health insurance coverage resulting from implementation of the ACA, Hispanic/Latinx patients continue to experience ongoing health inequities including higher reported rates of cancer and higher reported limitations in activities because of emotional or mental health. Residual obstacles to health care access for Hispanic/ Latinx patients included difficulty in finding providers who accepted their insurance or would see them regardless of insurance, as well as language barriers when trying to get care. WHAT WE DID: Data from 2010 to 2019 Association of American Medical Colleges Consumer Survey of Health Care Access were retrospectively reviewed. The measure of interest was self-identification as Hispanic/ Latinx. Descriptive statistics and univariate and mul-tivariate comparisons of patterns pre-versus post-ACA were performed. WHAT WE FOUND: In a total cohort of 53,523 respondents , Hispanic/Latinx comprised 7.5% (n 5 4,094). Post-ACA demographics showed a higher proportion were female, employed, and educated and had higher income and private insurance coverage, with a decrease in being uninsured. There were a significant increase in those who were always able to get care when needed and a decrease in those who were only able to get care some of the time or never. Reasons for being unable to get necessary care increased for those reporting difficulty in finding a provider who would see them regardless of insurance. There was also a significantly higher proportion of respondents reporting language as a barrier in trying to get routine or ongoing care in the past 12 months. Adjusted models showed that post-ACA Hispanic/Latinx are less likely to use emergency room if sick or needing medical advice (odds ratio [OR] 0.33; P , .001) and more likely to report chronic conditions involving cancer (OR 2.43; P , .001) or being limited in activities because of mental or emotional problems (OR 1.36; P 5 .005). BIAS, CONFOUNDING FACTORS, DRAWBACKS: The Hispanic/Latinx population is heterogeneous and can be oversimplified when evaluated as a single entity. In addition, data on immigration status, including citizenship/residency and number of years in the United States, are also of key importance when evaluating the impact of the ACA on Hispanic/Latinx patients in the United States. Future studies on the basis of disaggregated data, including immigration variables, will be needed to better understand the nuanced experiences of individual Hispanic/Latinx populations. REAL-LIFE IMPLICATIONS: The Hispanic/Latinx population is predicted to make up a large extent of the workforce and subsequent revenue in the coming years. This study adds value to the existing literature by using a new data source, representative of the US population, taken at multiple different time points. Interesting observations seen in the data were the decrease in emergency room visits and an increase in utilization of health care providers' offices. The current study serves as a starting point, through use of a nationally representative sample, to improve our current understanding of the Hispanic/Latinx experience with the health care system and can help create ac-tionable policy changes at institutional, local, and national levels. abstract PURPOSE Hispanic/Latinx communities encounter disparities in access and availability of appropriate timely health care services, negatively affecting cancer outcomes. Limited data exist on the role of these factors in personal experiences of Hispanic/Latinx with health care systems. We aim to better understand Hispanic/Latinx experience with the health care system, focusing on the impact of the Affordable Care Act (ACA) and applications to clinical practice in patients diagnosed with cancer. METHODS Competitively obtained data from 2010 to 2019 Association of American Medical Colleges Consumer Survey of Health Care Access (a US population-based sample of potential health care consumers needing health care at least once in the past year) were retrospectively reviewed. Descriptive statistics and univariate and multivariate comparisons of patterns pre-versus post-ACA were performed for respondents self-identifying as Hispanic/Latinx. RESULTS In a total cohort of 53,523 respondents, Hispanic/Latinx comprised 7.5% (n 5 4,094). Post-ACA demographics showed a higher proportion of female and an increase in employment, educational attainment, income, and private insurance coverage, with a decrease in uninsured. Adjusted models showed that post-ACA Hispanic/Latinx patients are less likely to use emergency room if sick or needing medical advice (odds ratio [OR] 0.33; P , .001) and more likely to report chronic conditions involving cancer (OR 2.43; P , .001) or being limited in activities because of mental or emotional problems (OR 1.36; P 5 .005). CONCLUSION Although ACA implementation was associated with decreased health care access barriers in Hispanic/Latinx, they continue to experience disparities in chronic health conditions, including cancer, with higher limitations because of emotional or mental health. Ongoing efforts that build upon current strides, toward improved patient satisfaction and overall outcomes, are of paramount importance.