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Access to Care

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Mexicans' access to primary care is limited overall, but worse in nonmetropolitan areas

A growing number of Latinos in the United States are moving to nonmetropolitan areas. Findings from a new study of the Medical Expenditure Panel Survey (MEPS) 2002-2003 indicate that nonmetro Mexicans face even more barriers to obtaining timely health care compared with their metropolitan counterparts.

After controlling for other factors affecting health care access, such as income and insurance, Mexicans in metro areas were no less likely to have a usual source of care than whites living in metro areas. However, Mexicans living in nonmetro areas were 45 percent less likely than metro whites and 49 percent less likely than metro Mexicans to have a usual source of care. The measure of physician visits in the past year did not show as clear a geographic pattern, with Mexicans in both metro and nonmetro areas having 33 percent fewer outpatient visits than whites.

Nonmetropolitan areas have seen an unprecedented growth in the Latino population, particularly in areas of the Midwest and South. Given these recent demographic trends, providers may be less prepared to provide adequate services to them than those in metro areas, note Terceira A. Berdahl, Ph.D., and James B. Kirby, Ph.D., of the Agency for Healthcare Research and Quality. For example, nonmetro providers may be less likely to speak Spanish or provide interpreters for their patients. This may make it more difficult for Mexicans to find a usual source of care compared with whites and urban Mexicans. Mexicans may also face more marginalization in smaller nonmetro communities, where their social positions are tenuous and they have fewer ethnic connections, explain the researchers.

Along with Rosalie Torres Stone, Ph.D., of the University of Massachusetts Medical School, they analyzed nationally representative data on working-aged adults from the 2002-2003 MEPS. The researchers examined individuals' reports of having a provider from whom they usually obtained medical care (potential care access), and reports of having a physician visit during the year (realized care access). They also studied English language proficiency and time spent in the United States, factors that affect health care access for Latinos.

See "Access to health care for nonmetro and metro Latinos of Mexican origin in the United States," by Drs. Berdahl, Kirby, and Stone, in the July 2007 Medical Care 45(7), pp. 647-654.

Reprints (AHRQ Publication No. 07-R059) are available from the AHRQ Publications Clearinghouse.


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