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Language difficulties are as much of a barrier to health care for some Latinos as being uninsured

Limited ability to speak English among Spanish-speaking Latinos dissuades them from seeing a doctor for health problems as much as a lack of health insurance does, according to a new study. This is particularly troublesome, since growing numbers of poor Spanish-speaking patients are entering Medicaid managed care plans, which have few interpreters and culturally competent staff to help these patients communicate. These plans need to develop effective systems to improve communication between health care providers and patients, conclude Kathryn Pitkin Derose, M.P.H., of the University of California, Los Angeles, and David W. Baker, M.D., M.P.H., of Case Western Reserve University.

In their study, which was supported by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00046), they interviewed 465 Spanish-speaking Latinos (mostly Mexican Americans) and 259 English speakers of various ethnicities, who visited a hospital emergency department in 1993 and 1994. The researchers analyzed patient demographics, health insurance status, source of care, health status, and number of outpatient physician visits in the prior 3 months. They also gave study participants an English literacy test. Among those patients who saw a physician at least once, Latinos with fair and poor English proficiency reported about 22 percent fewer later physician visits than non-Latinos whose native language was English, after adjustment for other determinants of doctors' visits. There was no difference in physician visits between Latinos with good English proficiency and English-speaking non-Latinos.

The barrier to health care for Latinos with poor English proficiency was similar to barriers presented by lack of insurance and lack of a regular source of care. For example, Medicaid patients reported 42 percent more visits than uninsured patients, and patients with a regular source of care reported 41 percent more physician visits than those who had no regular source of care. This lower use of physician services by Latinos who have difficulty speaking English is disturbing, especially since in this study more than half of these patients rated their usual health as fair or poor.

See "Limited English proficiency and Latinos' use of physician services," by Drs. Derose and Baker, in the March 2000 Medical Care Research and Review 57(1), pp. 76-91.

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