Effects of health insurance on perceived quality of care among Latinos in the United States.

BACKGROUND

There is suggestive evidence that lower rates of health insurance coverage increases the gaps in quality and access to care among Latinos as compared with non-Latino whites. In order to examine these potential disparities, we assessed the effects of insurance coverage and multiple covariates on perceived quality of care.

OBJECTIVE

To assess the distribution of perceived quality of care received in a national Latino population sample, and the role of insurance in different patient subgroups.

DESIGN

Telephone interviews conducted between 2007 and 2008 using the Pew Hispanic Center/Robert Wood Johnson Foundation Latino Health Surveys (Waves 1 and 2).

PARTICIPANTS

Randomly selected Latino adults aged >or=18 years living in the United States.

MEASUREMENTS

Pearson chi(2) tests identified associations among various demographic variables by quality of care ratings (poor, fair, good, excellent) for the insured and uninsured (Wave 1: N = 3545). Subgroup analyses were conducted among Wave 2 participants reporting chronic conditions (N = 1067). Bivariate and multivariate analyses were conducted to estimate the effects of insurance, demographic variables and consumer characteristics on quality of care.

RESULTS

Insurance availability had an odds ratio of 1.47 (95% CI, 1.22-1.76) net of confounders in predicting perceived quality of care among Latinos. The largest gap in rates of excellent/good ratings occurred among the insured with eight or more doctor visits compared to the uninsured (76.2% vs. 54.6%, P < .05).

CONCLUSIONS

Future research can gain additional insights by examining the impact of health insurance on processes of care with a refined focus on specific transactions between consumers and providers' support staff and physicians guided by the principles of patient-centered care.