JSI Research and Training Institute, Boston, Massachusetts, USA.
Health Aff (Millwood). 2011 Aug;30(8):1451-60. doi: 10.1377/hlthaff.2011.0347.
Hispanics are more likely than any other racial or ethnic group in the United States to lack health insurance. This paper draws on quantitative and qualitative research to evaluate the extent to which health reforms in Massachusetts, a model for the Affordable Care Act of 2010, have reduced disparities in insurance coverage and access to health care. We found that rates of coverage and the likelihood of having a usual provider increased dramatically for Massachusetts Hispanics after the state's reforms, but disparities remained. The increase in insurance coverage among Hispanics was more than double that experienced by non-Hispanic whites. Even so, in 2009, 78.9 percent of Hispanics had coverage, versus 96 percent of non-Hispanic whites. Language and other cultural factors remained significant barriers: Only 66.6 percent of Hispanics with limited proficiency in English were insured. One-third of Spanish-speaking Hispanics still did not have a personal provider in 2009, and 26.8 percent reported not seeing a doctor because of cost, up from 18.9 percent in 2005. We suggest ways to reduce such disparities through national health care reform, including simplified enrollment and reenrollment processes and assistance in finding a provider and navigating an unfamiliar care system.
在美国,西班牙裔人比任何其他种族或族裔群体都更有可能没有医疗保险。本文利用定量和定性研究来评估马萨诸塞州(2010 年平价医疗法案的典范)的医疗改革在多大程度上减少了保险覆盖范围和获得医疗保健方面的差异。我们发现,在该州改革之后,马萨诸塞州西班牙裔人的保险覆盖率和拥有常规提供者的可能性大幅提高,但差距仍然存在。西班牙裔人的保险覆盖率增长超过非西班牙裔白人的两倍。即便如此,2009 年,仍有 78.9%的西班牙裔人有保险,而非西班牙裔白人的这一比例为 96%。语言和其他文化因素仍然是重大障碍:只有 66.6%英语水平有限的西班牙裔人有保险。三分之一的讲西班牙语的西班牙裔人在 2009 年仍然没有个人提供者,26.8%的人因为费用而不去看医生,高于 2005 年的 18.9%。我们提出了通过国家医疗保健改革来减少这些差异的方法,包括简化注册和重新注册流程,以及在寻找提供者和熟悉不熟悉的医疗系统方面提供帮助。