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Health Care Costs and Financing

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Improved health insurance coverage may enhance access to care among rural Hispanic elders

Elderly Hispanics living in rural areas find it more difficult than their white counterparts to see their personal doctor for routine care or injury/illness when wanted. They also find it more difficult to see a specialist or obtain transportation to the clinic, according to a recent study. Enabling factors such as health insurance have a greater effect than ethnicity on their ability to obtain care, concludes Tyrone F. Borders, Ph.D., of the University of North Texas Health Sciences Center. The study was supported in part by the Agency for Healthcare Research and Quality (HS11606).

Dr. Borders conducted a telephone survey of 2,097 rural community-dwelling elders in West Texas about their ability to see a personal doctor/nurse, see a specialist, obtain help over the phone, and obtain transportation to the clinic. The survey also asked about factors that might facilitate or impede the respondents' ability to access care. Hispanic participants had lower income and were less likely to have health insurance than the elderly whites who were surveyed. More Hispanics also had diabetes, and they had lower mental health scores than whites.

After accounting for several factors affecting receipt of care, Hispanic ethnicity was not directly associated with the ability to obtain care. However, age was important. The oldest old (80 years and older) were less likely to always/usually see their personal doctor/nurse than those aged 65 to 70 years. Elders with higher income were more likely to obtain transportation to the clinic. Those with Medicare and supplemental private or government coverage were more likely to see their personal doctor/nurse than those without insurance. Similarly, individuals with Medicare only, Medicare plus other private or government coverage, and Medicaid only were more likely to see a specialist when they needed to. Finally, those with poorer health were less likely to see a specialist.

See "Rural community-dwelling elders' reports of access to care: Are there Hispanic versus non-Hispanic white disparities?" by Dr. Borders, in the Summer 2004 Journal of Rural Health 20(3), pp. 210-220.

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