Foiles Sifuentes Andriana M, Robledo Cornejo Monica, Li Nien Chen, Castaneda-Avila Maira A, Tjia Jennifer, Lapane Kate L
Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Department of Anthropology, Sonoma State University, Rohnert Park, California, USA.
Health Equity. 2020 Dec 11;4(1):509-517. doi: 10.1089/heq.2020.0057. eCollection 2020.
Limited English proficiency adversely impacts people's ability to access health services. This study examines the association between English language proficiency and insurance access and use of a usual care provider after the implementation of the Affordable Care Act (ACA). Using cross-sectional data from the 2016 Medical Panel Expenditures Survey, we identified 24,099 adults (weighted =240,035,048) and categorized them by self-reported English-language proficiency. We classified participants according to responses to: "How well do you speak English? Would you say… Very well; well; Not well; Not at all?" (having limited English proficiency: not well; not at all, English proficient: well; very well; and English only: not applicable) and "What language do you speak at home? Would you say… English, Spanish, Other." Using these two recoded variables, we created a variable with five categories: (1) Spanish speaking, with limited English proficiency, (2) other language speaking, with limited English proficiency, (3) Spanish speaking, English proficient, (4) other language speaking, English proficient, and (5) English only. Health insurance and usual care provider were determined by self-report. Among those <65 years, the percent covered by public insurance (Spanish: 21%, Other languages: 28%, English only 14%), who were uninsured (Spanish: 46%, Other languages: 17%, English only: 8%), and who lacked a usual care provider (Spanish: 45%, Other languages: 35%, English only: 26%) differed by English language proficiency. Among those ≥65 years, fewer people with limited English proficiency relative to English only were dually covered by Medicare and private insurance (Spanish: 12%, Other languages: 15%, English only: 59%), and a higher percent lacked a usual care provider (Spanish: 15%, Other languages: 11%, English only: 7%). Differences persisted with adjustment for covariates. Post the ACA, persons with limited English proficiency remain at a risk of being uninsured relative to those who only speak English.
英语水平有限会对人们获得医疗服务的能力产生不利影响。本研究考察了《平价医疗法案》（ACA）实施后英语水平与保险获取及常规医疗服务提供者使用之间的关联。利用2016年医疗支出小组调查的横断面数据，我们识别出24,099名成年人（加权后为240,035,048），并根据自我报告的英语水平对他们进行分类。我们根据对以下问题的回答对参与者进行分类：“你的英语说得怎么样？你会说……非常好；好；不好；完全不会？”（英语水平有限：不好；完全不会，英语熟练：好；非常好；只会说英语：不适用）以及“你在家说什么语言？你会说……英语、西班牙语、其他。”利用这两个重新编码的变量，我们创建了一个有五个类别的变量：（1）说西班牙语，英语水平有限，（2）说其他语言，英语水平有限，（3）说西班牙语，英语熟练，（4）说其他语言，英语熟练，（5）只会说英语。医疗保险和常规医疗服务提供者由自我报告确定。在65岁以下人群中，公共保险覆盖的比例（西班牙语：21%，其他语言：28%，只会说英语：14%）、未参保的比例（西班牙语：46%，其他语言：17%，只会说英语：8%）以及没有常规医疗服务提供者的比例（西班牙语：45%，其他语言：35%，只会说英语：26%）因英语水平而异。在65岁及以上人群中，与只会说英语的人相比，英语水平有限的人同时拥有医疗保险和私人保险的比例更低（西班牙语：12%，其他语言：15%，只会说英语：59%），且没有常规医疗服务提供者的比例更高（西班牙语：15%，其他语言：11%，只会说英语：7%）。在对协变量进行调整后，差异仍然存在。《平价医疗法案》实施后，英语水平有限的人相对于只会说英语的人仍有未参保的风险。
