Valdez R B, Giachello A, Rodriguez-Trias H, Gomez P, de la Rocha C
School of Public Health, UCLA 90024-1772.
Public Health Rep. 1993 Sep-Oct;108(5):534-9.
Public debate about health care reform often focuses on the need for health insurance coverage, but in Latino communities many other barriers also inhibit access to medical care. In addition, basic public health services often go underfunded or ignored. Thus, health care reform efforts, nationally and in each State, must embrace a broader view of the issues if the needs of Latino communities are to be served. This report reviews and summarizes information about the mounting problems Latino communities face in gaining access to medical care. Access to appropriate medical care is reduced by numerous financial, structural, and institutional barriers. Financial barriers include the lack of health insurance coverage and low family incomes common in Latino communities. More than 7 million Latinos (39 percent) go without health insurance coverage. Latinos without health insurance receive about half as much medical care as those who are insured. Structurally, the delivery system organization rarely reflects the cultural or social concerns of the communities where they are located. Therefore, providers and patients fail to communicate their concerns adequately. These communication problems are exacerbated by the extreme shortage of Latino health care professionals and other resources available. Institutional barriers often reflect the failure to consider what it means to provide good service as well as high-quality medical care. Reducing these barriers to medical care requires modifying governmental and institutional policies, expanding the supply of competent providers, restructuring delivery system incentives to ensure primary care and public health services, and enhancing service and satisfaction with care.
关于医疗保健改革的公开辩论通常聚焦于医疗保险覆盖范围的必要性，但在拉丁裔社区，许多其他障碍也阻碍了人们获得医疗服务。此外，基本公共卫生服务往往资金不足或被忽视。因此，如果要满足拉丁裔社区的需求，全国和各州的医疗保健改革努力必须对这些问题有更广泛的认识。本报告回顾并总结了拉丁裔社区在获得医疗服务方面面临的日益严重问题的相关信息。获得适当医疗服务受到众多财务、结构和制度障碍的限制。财务障碍包括缺乏医疗保险覆盖以及拉丁裔社区常见的家庭收入较低。超过700万拉丁裔（39%）没有医疗保险覆盖。没有医疗保险的拉丁裔获得的医疗服务约为有保险者的一半。在结构上，医疗服务提供系统的组织很少反映其所在社区的文化或社会关切。因此，医疗服务提供者和患者无法充分沟通他们的关切。拉丁裔医疗保健专业人员和其他可用资源的极度短缺加剧了这些沟通问题。制度障碍往往反映出未能考虑提供优质服务以及高质量医疗保健意味着什么。减少这些医疗服务障碍需要修改政府和机构政策，增加合格医疗服务提供者的供应，调整医疗服务提供系统的激励措施以确保初级保健和公共卫生服务，并提高服务质量和就医满意度。
