Wagner T H, Guendelman S
VA HSR&D Health Economics Resource Center, Menlo Park, CA 94025, USA.
Am J Manag Care. 2000 Mar;6(3):355-64.
To assess the effects of health need, enabling factors, and predisposing factors on entry into any type of care, volume of care, use of emergency services, hospitalization, and receipt of preventive services.
Multiple regression analysis with cross-sectional data.
Participants were the 1001 adults who identified themselves as Hispanic in the Commonwealth Fund Minority Health Survey; a telephone survey of noninstitutionalized persons designed to oversample minorities was conducted.
The 3 Hispanic subpopulations had similar sociodemographic profiles and similar patterns of healthcare utilization, except that Hispanics of other national origins were more likely to use preventive care compared with Mexican Americans and Puerto Ricans. Overall, 78% of the Hispanics surveyed entered the healthcare system in the past year, making an average of 5.25 visits. After controlling for other factors, immigrants had fewer visits and were less likely to have received preventive care. A regular source of care and insurance coverage influenced entry and volume of care, but was not associated with emergency services or hospitalizations.
Access to care for Hispanics remains a major problem, significantly affected by structural and financial factors, personal experiences with the healthcare system, and predisposing factors. Policy solutions that address the health service needs of the uninsured will largely benefit Hispanics. In addition, as managed care plans compete for contracts and become more multicultural, access to care for Hispanics, including the uninsured, may improve through market forces.
评估健康需求、促成因素和诱发因素对进入任何类型护理、护理量、急诊服务使用、住院治疗以及预防服务接受情况的影响。
对横断面数据进行多元回归分析。
参与者为在联邦基金少数族裔健康调查中自认为是西班牙裔的1001名成年人；该调查是对非机构化人员进行的电话调查，旨在对少数族裔进行过度抽样。
这3个西班牙裔亚群体具有相似的社会人口学特征和相似的医疗保健利用模式，只是与墨西哥裔美国人和波多黎各人相比，其他国籍的西班牙裔更有可能使用预防性护理。总体而言，78%的接受调查的西班牙裔在过去一年进入了医疗保健系统，平均就诊5.25次。在控制其他因素后，移民的就诊次数较少，接受预防性护理的可能性也较小。常规护理来源和保险覆盖范围影响了护理的进入和量，但与急诊服务或住院治疗无关。
西班牙裔获得护理的机会仍然是一个主要问题，受到结构和财务因素、在医疗保健系统中的个人经历以及诱发因素的显著影响。解决未参保者健康服务需求的政策解决方案将在很大程度上使西班牙裔受益。此外，随着管理式医疗计划争夺合同并变得更加多元文化，包括未参保者在内的西班牙裔获得护理的机会可能会通过市场力量得到改善。
