The Greater Los Angeles VA Healthcare System, University of California, Los Angeles, CA, 90073, USA.
J Immigr Minor Health. 2011 Apr;13(2):260-7. doi: 10.1007/s10903-010-9425-6.
Studies suggest that proximity to a safety net clinic (SNC) promotes access to care among the uninsured. Distance-based barriers to care may be greater for people with limited English proficiency (LEP), compared to those who are English proficient (EP), but this has not been explored. We assessed the relationship between distance to the nearest SNC and access in non-rural uninsured adults in California, and examined whether this relationship differs by language proficiency. Using the 2005 California Health Interview Survey and a list we compiled of California's SNCs, we calculated distance between uninsured interviewee residence and the exact address of the nearest SNC. Using multivariate regression to adjust for other relevant characteristics, we examined associations between this distance and interviewee's probability of having a usual source of health care (USOC) and having visited a physician in the prior 12 months. To examine differences by language proficiency, we included interactions between distance and language proficiency. Uninsured LEP adults living within 2 miles of a SNC were 9.3% less likely than their EP counterparts to have a USOC (P = 0.046). Further, distance to the nearest SNC was inversely associated with the probability of having a USOC among LEP, but not among EP; consequently, the difference between LEP and EP in the probability of having a USOC widened with increasing distance to the nearest SNC. There was no difference between LEP and EP adults living within 2 miles of a SNC in likelihood of having a physician visit; however, as with USOC, distance to the nearest SNC was inversely associated with the probability of having a physician visit among LEP but not EP. The effect sizes diminished, but remained significant, when we included county fixed effects in the models. Having LEP is a barrier to health care access, which compounds when combined with increased distance to the nearest SNC, among uninsured adults. Future studies should explore potential mechanisms so that appropriate interventions can be implemented.
研究表明，靠近安全网诊所（SNC）可促进未参保人群获得医疗服务。与英语熟练者（EP）相比，英语水平有限（LEP）的人可能面临更大的基于距离的医疗服务障碍，但这一点尚未得到探讨。我们评估了距离最近的 SNC 与加利福尼亚州非农村未参保成年人获得医疗服务之间的关系，并研究了这种关系是否因语言熟练程度而异。我们使用 2005 年加利福尼亚健康访谈调查和我们编制的加利福尼亚 SNC 清单，计算了未参保受访者居住地与最近 SNC 的确切地址之间的距离。使用多元回归调整其他相关特征后，我们检查了此距离与受访者是否有常规医疗服务来源（USOC）和在过去 12 个月内就诊医生的可能性之间的关联。为了检查语言熟练程度的差异，我们在距离和语言熟练程度之间包含了交互作用。居住在 SNC 2 英里范围内的未参保 LEP 成年人比 EP 成年人获得 USOC 的可能性低 9.3%（P=0.046）。此外，距离最近的 SNC 与 LEP 获得 USOC 的可能性呈反比，但与 EP 无关；因此，随着距离最近的 SNC 越来越远，LEP 和 EP 在获得 USOC 的可能性方面的差异也越来越大。居住在 SNC 2 英里范围内的 LEP 和 EP 成年人在就诊医生的可能性方面没有差异；然而，与 USOC 一样，距离最近的 SNC 与 LEP 就诊的可能性呈反比，但与 EP 无关。当我们在模型中包含县固定效应时，效应大小减小，但仍具有统计学意义。在未参保成年人中，LEP 是获得医疗服务的障碍，当与距离最近的 SNC 增加相结合时，这种障碍会更加严重。未来的研究应该探索潜在的机制，以便能够实施适当的干预措施。
