Hispanics and Health Care in the United States: Access, Information and Knowledge

WASHINGTON (By Gretchen Livingston, Susan Minushkin, D'Vera Cohn, Pew Research Center) December 8, 2008 — More than one-fourth of Hispanic adults in the U.S. lack a usual health care provider, and a similar proportion report obtaining no health care information from medical personnel in the past year. At the same time, more than eight in ten report receiving health information from media sources, such as television and radio, according to a Pew Hispanic Center survey of Hispanic adults, conducted in conjunction with the Robert Wood Johnson Foundation.

Previous research by the U.S. Centers for Disease Control and Prevention has shown Hispanics are about twice as likely as non-Hispanic blacks and three times as likely as non-Hispanic whites to lack a regular health care provider. Hispanics are a diverse community, and the 2007 Hispanic Health Survey explores not only their access to health care, but also their sources of health information and their knowledge about a key disease (diabetes) at greater depth and breadth than any national survey done to date by another research organization or the federal government.

It finds among Hispanic adults, the groups least likely to have a usual health care provider are men, the young, the less educated and those with no health insurance. A similar demographic pattern applies to the non-Hispanic adult population lacks a regular health care provider. The new survey also finds foreign-born and less-assimilated Hispanics — those who mainly speak Spanish, who lack U.S. citizenship, or who have had only short tenures in the United States — are less likely than other Hispanics to report they have a usual place to go for medical treatment or advice.

Nevertheless, a significant share of Hispanics with no usual place to go for medical care are high school graduates (50%), born in the United States (30%) and have health insurance (45%). Indeed, the primary reason respondents give for lacking a regular health care provider is not related to the cost of health care or assimilation. Rather, when asked why they lack a usual provider, a plurality (41%) of respondents say the principal reason is  they are seldom sick.

As for sources of health information, about seven in ten Hispanics (71%) report they received information from a doctor in the past year. An equal proportion report obtaining health information through their social networks, including family, friends, church groups and community groups. An even larger number — 83% — report they obtained health information from some branch of the media, with television being the dominant source.

Not only are most Hispanics obtaining information from media sources, but a sizeable proportion — 79% — say they are acting on this information. It is beyond the scope of this report to assess the accuracy and usefulness of health information obtained from non-medical sources. But the survey findings clearly demonstrate the power and potential of these alternative outlets to disseminate health information to the disparate segments of the Hispanic population.

Regarding the quality of the health care they receive, Hispanics are generally pleased, according to the survey. Among Hispanics who have received health care in the past year, 77% rate care as good or excellent. However, almost one-in-four who received health care in the past five years report having received poor quality medical treatment. Those who believe the quality of their medical care was poor attribute it to their financial limitations (31%), their race or ethnicity (29%) or, the way they speak English or their accent (23%).

The Hispanic population in the United States has more than doubled in size in the past 15 years and is now estimated to have reached 45 million. This rapid expansion, combined with the increasing heterogeneity of the nationalities composing the Hispanic population, underlines the need for up-to-date, accurate information on Hispanics  takes into account their growing diversity.

Health care is one realm where such information is especially critical. When it comes to Hispanics, what may appear to be the well-known effects of socioeconomic inequality on health care may also be conditioned by unique social, cultural and economic circumstances confronting both Hispanic immigrants and Hispanics born in the United States.

With the heterogeneity of the Hispanic population in mind, the Robert Wood Johnson Foundation and the Pew Hispanic Center designed this survey to provide up-to-date, accurate information on Hispanics and health care in the United States. This report focuses on how the diverse characteristics of the Hispanic population influence their health information needs, their help-seeking behaviors, their access to health services, their perceptions of the quality of health care, and their level of understanding of chronic disease.

The vast growth and the increasing diversity of the Hispanic population create a challenge for improving public health interventions and reducing medical care disparities. This report seeks to address  challenge by providing information  we hope will be of use to policy-makers, the medical and public health communities, and the media.

OVERVIEW AND EXECUTIVE SUMMARY

More than one-fourth of Hispanic adults in the United States lack a usual health care provider, and a similar proportion report obtaining no health care information from medical personnel in the past year. At the same time, more than eight in 10 report receiving health information from alternative sources, such as television and radio, according to a Pew Hispanic Center (PHC) survey of Hispanic adults, conducted in conjunction with the Robert Wood Johnson Foundation (RWJF).

Hispanics are the nation’s largest and fastest growing minority group. They currently make up about 15 percent of the U.S. population, and this figure is projected to nearly double to 29 percent by 2050, if current demographic trends continue.1 Even after adjusting for their relative youth, Hispanic adults have a lower prevalence of many chronic health conditions than the U.S. adult population as a whole. However, they have a higher prevalence of diabetes than do non-Hispanic white adults, and they are also more likely to be overweight. This greater propensity to be overweight puts them at an increased risk to develop diabetes and other serious health conditions.

Question wording: Is there a place you usually go to when you are sick or need advice about your health?

Source: Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Health Survey.

Previous research by the U.S. Centers for Disease Control and Prevention has shown  Hispanics are twice as likely as non-Hispanic blacks and three times as likely as non-Hispanic whites to lack a regular health care provider.3 Hispanics are a diverse community, and the Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Health survey of 4,013 Hispanic adults explores not only their access to health care, but also their sources of health information and their knowledge about a key disease (diabetes) at greater depth and breadth than any national survey done to date by other research organizations or the federal government.

It finds among Hispanic adults, the groups least likely to have a usual health care provider are men, the young, the less educated, and those with no health insurance. A similar demographic pattern applies to the non-Hispanic adult population. The new survey also finds  foreign-born and less-assimilated Hispanics—those who mainly speak Spanish, who lack U.S. citizenship, or who have been in the United States for a short time—are less likely than other Hispanics to report  they have a usual place to go for medical treatment or advice.

Nevertheless, a significant share of Hispanics with no usual place to go for medical care are high school graduates (50 percent), were born in the United States (30 percent) and have health insurance (45 percent). Indeed, the primary reason survey respondents give for lacking a regular health care provider is not related to the cost of health care or assimilation. Rather, when asked about why they lack a usual provider, a plurality of respondents (41 percent) say the principal reason is they are seldom sick.

As for sources of health information, about seven in 10 Hispanics (71 percent) report they received information from a doctor in the past year. An equal proportion report obtaining health information through their social networks, including family, friends, churches, and community groups. An even larger share (83 percent) report they obtained health information from some branch of the media, with television being the dominant source.

Not only are most Hispanics obtaining information from media sources, but a sizeable proportion (79 percent) say they are acting on this information. It is beyond the scope of this report to assess the accuracy and usefulness of health information obtained from non-medical sources, but the survey findings clearly demonstrate the power and potential of these alternative outlets to disseminate health information to the disparate segments of the Hispanic population.

Regarding the quality of the health care they receive, Hispanics are generally pleased, according to the survey. Among Hispanics who have received health care in the past year, 78 percent rate care as good or excellent. However, almost one in four who received health care in the past five years reported having received poor quality medical treatment. Those who believed the quality of their medical care was poor attribute it to their financial limitations (31 percent), their race or ethnicity (29 percent), or the way they speak English or their accent (23 percent).

The PHC/RWJF survey also asked respondents a battery of eight knowledge questions about diabetes, a condition  afflicts an estimated 9.5 percent of Hispanic adults, compared with 8.7 percent of non-Hispanic whites.4* Nearly six in 10 respondents (58 percent) answered at least six of the eight diabetes questions correctly. Better educated and more assimilated Hispanics scored better, as did those with a usual health care provider.

The Likelihood of Having a Usual Health Care Provider

Some 73 percent of Hispanic adults report having a usual place where they seek medical help or advice, while 27 percent have no usual health care provider. As in the general population, males, the young, and the less educated are less likely to have a usual health care provider.

• 36 percent of men lack a usual provider, compared with 17 percent of women.

* These figures represent the overall prevalence of diabetes. For age-adjusted statistics on the prevalence of diabetes.

• 37 percent of persons ages 18–29 lack a regular place to obtain health care, compared with 13 percent of persons ages 65 or older.

• 32 percent of adults with less than a high school diploma lack access to a regular place for health care, compared with 19 percent of people with at least some college education.

Foreign-born and less assimilated Hispanics are less likely than other Hispanics to have a usual health care provider.

• 30 percent of Hispanics born outside of the 50 states lack a usual place for health care, compared with 22 percent of U.S.-born Hispanics.

• 32 percent of Hispanics who mainly speak Spanish lack a regular health care provider, compared with 22 percent of Hispanics who mainly speak English.

• 49 percent of Hispanics who have lived in the United States for less than five years lack a usual health care provider, compared with 21 percent of those who have lived in the United States for 15 years or more.

Some 42 percent of the Hispanics who have no health insurance lack a usual health care provider, compared with 19 percent of the insured.

Profile of Persons Who Lack a Usual Health Care Provider

The primary reason respondents give for not having a regular health care provider is their belief they do not need one.

• 41 percent of those lacking a regular provider say they are seldom sick, and 13 percent say they prefer to treat themselves.

• 17 percent report a lack of health insurance as the primary reason they don’t have a regular provider, and 11 percent report the cost of health care is prohibitive.

• 3 percent report they have trouble navigating the U.S. health care system.

• A significant share of Hispanic adults who lack a regular health care provider are native born, have a high school diploma, speak English and have health insurance.

• 50 percent of those with no usual health care provider are at least high school graduates.

• 30 percent of those with no usual health care provider were born in the United States.

• 52 percent of those with no usual health care provider speak predominantly English or are bilingual.

• 45 percent of those with no usual health care provider have health insurance.

Quality of Health Care

77 percent of Hispanics who have received health care in the past year rate care as good or excellent.

Of those Hispanics who have received health care in the past year, assessments of the quality of care are higher rated among those who have health insurance and a usual health care provider.

• 80 percent of people with a usual health care provider state their health care was good or excellent, compared with 64 percent of people with no usual health care provider.

• 80 percent of the insured rate their health care as good or excellent, compared with 70 percent of the uninsured. Of those respondents who have received health care in the past five years, 23 percent report having received poor-quality medical treatment

• A plurality (31 percent) attribute this poor treatment to their financial limitations.

• 29 percent attribute the poor treatment to their race or ethnicity.

• 23 percent report their accent or the manner in which they speak

English contributed to their poor treatment.

Health Information Sources

Some 71 percent of Hispanics report getting information from a medical professional in the past year, while 28 percent report having obtained no information at all from a health care professional in time. Most Hispanics receive information about health care either from the media, or from their families, friends, churches and community groups.

• 83 percent report obtaining at least some information about health and health care from television, radio, newspapers, magazines or the Internet in the past year.

• 70 percent report obtaining information from family and friends, or churches and community groups in the past year.

Television is an especially powerful conduit of information; 68 percent of Hispanics report obtaining health information from television in the past year.

Not only are Hispanics obtaining a substantial amount of health information from the media, but they are making behavioral changes based on what they learn.

• 64 percent report the health information they obtained from the media led them to change their diet or exercise regimes.

• 57 percent report the health information they obtained from the media led them to visit a health care professional.

• 41 percent say the information they obtained from the media affected their decision about how to treat an illness or medical condition.

Diabetes Knowledge

In a battery of eight questions assessing diabetes knowledge, 58 percent of respondents scored “high,” meaning they correctly answered six or more of the questions. Better-educated, more assimilated Hispanics are more knowledgeable about diabetes.

• 50 percent of adults lacking a high school diploma score high on the knowledge battery, compared with 70 percent of adults with at least some college education.

• 60 percent of naturalized citizens score high on the knowledge battery, compared with 48 percent of immigrant respondents who are neither citizens nor legal permanent residents.

• 50 percent of immigrants who have lived in the United States for less than five years score high on the knowledge battery, compared with 61 percent of immigrants who have lived in the United States for 15 years or more. 61 percent of adults with a usual place for health care scored high on the diabetes knowledge index, compared with 50 percent of adults with no usual place for health care.

Among adults diagnosed with diabetes, 73 percent scored high on the knowledge test, while 27 percent answered five or fewer questions correctly.

* The survey does not allow us to evaluate the validity of the health information obtained, or the appropriateness of subsequent behavioral changes respondents make.

CHAPTER 1 – INTRODUCTION: HISPANICS AND CHRONIC DISEASE IN THE U.S.

Chronic conditions have large impacts on U.S. health and medical spending. According to the Centers for Disease Control and Prevention, 133 million

U.S. residents have at least one chronic condition. Treating those diseases costs $1.5 trillion a year, which accounts for 75 percent of the nation’s spending on direct medical costs.5 Given the aging of the U.S. population, the prevalence of chronic disease and the rising costs of treatment, medical expenditures are expected to continue to go up.

The size and rapid growth of the Hispanic population offers considerable reason to focus on its chronic disease management. Hispanics will account for most of the U.S. population growth through 2050. While in 2007, Hispanics comprised 15 percent of the U.S. population, or about 45.5 million people,7 projections based on current demographic trends suggest  by 2050, they will comprise upwards of 29 percent of the population, or 128 million people.

Though they are now relatively youthful compared with the general population, Hispanics will account for a growing proportion of middle-aged and elderly

Americans in the future.

By 2050, for example, the Hispanic share of the elderly population will almost triple to 17 percent from 6 percent in 2005. Furthermore, growth in the Hispanic population increasingly will be driven by births in the United States, rather than immigration from abroad.9 Since U.S.-born Hispanics tend to be less healthy than Hispanic immigrants; this compositional change may further predispose the population to chronic illness.

At present, Hispanics have a lower prevalence of many conditions than the population as a whole, but they have a higher prevalence of diabetes than non-Hispanic whites. Furthermore, their rates of overweight and obese adults are relatively higher than those of non-Hispanic whites, which puts Hispanics at greater risk for the development of diabetes and other health conditions.

When people don’t get the information or treatment that would allow them to manage illnesses at an early stage or avoid a disease altogether, the costs of health care escalate and the burden of expensive late-stage medicine often falls to publicly funded health services. An important strategy to reduce chronic illness, and the costs associated with it, is through prevention via regular monitoring and educational initiatives.

According to the CDC, the proportion of Hispanics who report they have no usual place to receive health care is more than double that of non-Hispanic whites and non-Hispanic blacks.* Though it is more difficult to measure general knowledge and education about health issues among the population, the sheer diversity of the Hispanic population creates a challenge to information dissemination within medical environments as well as through public health campaigns.

In addition to divisions by gender, income and education, a number of other key characteristics distinguish Hispanics from each other. The language divide between Hispanics who are English speakers and those who are primarily Spanish speakers creates obstacles to public health campaigns and medical care.

Differences between U.S.-born Hispanics and Hispanic immigrants, between Hispanic immigrants from different countries of origin, as well as differing rates of assimilation by Hispanic immigrants add to the complexity of understanding this rapidly growing population and determining how best to convey health information to it.

* This cross-group pattern persists even controlling for age differences among the populations.

Source: National Health Interview Survey data from Pleis and Lethbridge–Cejku (2007).

CHAPTER 2 – UTILIZATION OF A USUAL HEALTH CARE PROVIDER AND SATISFACTION WITH HEALTH CARE

According to the survey results, more than one in four Hispanics (27 percent) lack a regular health care provider. Hispanics are a diverse population, and a variety of factors need to be considered to understand why some have regular providers and some don’t. Immigration and assimilation are factors, as large shares of Hispanics born outside of the United States and those who speak little English lack regular health care. Socioeconomic factors, such as education, immigration and language, weigh heavily in creating these disparities. However, there is also a substantial share of U.S.-born, fully assimilated Hispanics in the ranks of those with no usual health care provider.

Hispanics who are most likely to lack a usual place for health care include men (36 percent), the young (37 percent of those ages 18–29), and the less educated (32 percent of those lacking a high school diploma). Generally, Hispanics who are less assimilated into U.S. life are also at a disadvantage: 30 percent of those born outside of the 50 states, 32 percent of Spanish speakers and 43 percent of immigrants who are neither citizens nor legal permanent residents lack a regular health care provider.

The uninsured are more than twice as likely (42 percent) as the insured (19 percent) to lack a usual provider. Although lacking health insurance raises the likelihood of not having a usual health care provider, having health insurance in no way guarantees it. Of those without a usual source of health care, 45 percent have health insurance. Finally, even though the poorly educated and less assimilated are less likely to have a regular health care provider, they comprise only a portion of the population  falls into this category. A sizeable proportion of those with no usual place for health care have at least a high school diploma (50 percent), are native born (30 percent), are proficient in English (52 percent) or are U.S. citizens (50 percent).

* These results differ slightly from the statistic (32 percent) cited from the CDC, which is based on the National Health Interview Survey. For more information on NHIS methodology and variable definitions, see www.cdc.gov/nchs/nhis.htm.

IMPORTANCE OF HAVING A USUAL HEALTH CARE PROVIDER

Access to health care can be defined in any number of ways, but one widely used approach is to consider whether a person reports having a usual place to seek health care and advice. As is common practice,13 we consider any respondents who report having a place, other than an emergency room, “where they usually go when they are sick or need advice about their health,” other than an emergency room, as having a regular health care provider. We consider those who report having no usual place to obtain health care, or whose only usual place for health care is an emergency room, to be lacking a health care provider.

Defined this way, having a usual provider correlates with preventive care and monitoring.

And preventive care and monitoring are both associated with better long-term health outcomes, including better control of chronic conditions. Among Hispanics with a regular health care provider, 86 percent report a blood pressure check in the past two years, while only 62 percent of those lacking a provider report this. While almost three-fourths of those with a usual place to get health care report having their cholesterol checked in the past five years, fewer than half (44 percent) of those with no usual place have done so.

Hispanics generally are at heightened risk of diabetes, and three-fourths of those with a regular health care provider report having had a blood test to check this in the past five years, compared with only 49 percent of those lacking a regular health care provider. Among already-diagnosed diabetics, it is especially noteworthy , while 10 percent of those with a regular place for health care have not had a test to check their blood sugar in the past two years, this share jumps to 33 percent among those with no regular provider.

USUAL HEALTH CARE

PROVIDER

Respondents are considered to have a “usual” or “regular” health care provider or place to receive health care if they:

1. Report  they have a place where they usually go to when they are sick or need advice about their health, and

2. This usual place is not a hospital emergency room

THE LIKELIHOOD OF HAVING A USUAL HEALTH CARE PROVIDER

Our survey results find 73 percent of respondents have a usual health care provider and 27 percent of respondents lack a provider.

The lack of a regular health care provider varies markedly within the Hispanic population. For gender, age and education, the patterns mimic those in the general population.14 Hispanic men (36 percent) are more likely to lack a regular health care provider than women (17 percent). Younger Hispanics are especially likely to lack a regular health care provider: 37 percent of those ages 18–29 do not have one. This statistic declines with age; among respondents ages 65 and older, only 13 percent lack a regular health care provider. Higher levels of education are clearly associated with a higher likelihood of having a usual place to obtain health care. Only 19 percent of Hispanics with at least some college education lack usual health care access.  That rises to 27 percent for high school graduates, and to nearly one-third (32 percent) for those with less than a high school diploma. Place of birth and assimilation also play a role in the likelihood of having a regular health care provider. While 22 percent of U.S.-born Hispanics do not have a place where they usually go for medical care, this share increases to 30 percent among those born outside the 50 states. In general, less assimilated Hispanics are those most at risk of lacking a usual place for health care. Among naturalized and native-born Hispanic citizens, 21 to 22 percent lack a usual health care provider.

That compares with 31 percent of legal permanent residents and 43 percent: Differences in Preventive Care Monitoring Between Nativity and assimilation are both linked to the likelihood of having a regular health care provider.

That immigrants who are neither citizens nor legal permanent residents. Among all Hispanic immigrants, about half of recent arrivals—those in the country for less than five years—lack a usual place for health care, compared with 21 percent of those who have lived in the United States for at least 15 years. Hispanics who are predominantly Spanish speakers are much more likely to lack regular health care than their predominantly English-speaking counterparts (32 percent versus 22 percent).

Having health insurance is an important factor associated with having a usual place to obtain health care. While 42 percent of the uninsured lack a health care provider, only 19 percent of the insured do not have one.

Hispanic Adults’ Likelihood of Lacking a Usual Health Care

GETTING CARE OUTSIDE OF THE U.S.

About one in 12 Hispanics (8 percent) in the U.S. have obtained medical care, treatment or drugs in Latin America during the previous year, and one in six (17 percent) knows a family member or friend who has done so.

Hispanics who describe their recent medical care in the United States as only fair to poor are somewhat more likely to get medical services outside the country—11 percent have, compared with 6 percent of those who describe their care in this country as excellent. Hispanics without health insurance also are more likely to have received care in another country. Of those without insurance, 11 percent did; of those with insurance, 7 percent did. Of Hispanics with a regular provider in the U.S. medical system, 8 percent say they have gotten care abroad, compared with 10 percent of those with no regular provider.

Hispanics ages 65 and older are the least likely to seek care outside the United States (4 percent) and those ages 50–64 are the most likely (9 percent). Foreign-born Hispanics are somewhat more likely (9 percent) than the native born (6 percent) to get medical care in Latin America, and those from Mexico (10 percent) are more likely than non-Mexicans overall. A higher share of bilingual (10 percent) and Spanish-dominant (9 percent) Hispanics seek medical care in Latin America than do English speakers (4 percent).

One in 10 people with at least some college education report getting recent treatment or drugs in Latin America, compared with single-digit percentages for those with less education.

PROFILE OF HISPANICS LACKING A USUAL HEALTH CARE PROVIDER

Who are the Hispanics who are not being reached by the health care system?

This section looks at the characteristics of people who lack a usual health care provider.

Most Hispanics who lack a provider are male (69 percent). The population also tends to be young: 41 percent are 18–29 years of age, and 43 percent are 30–49. As is expected, Hispanics with low educational attainment comprise a large proportion of those lacking a provider; 47 percent report having less than a high school diploma. The vast majority of those with no usual place for health care are of Mexican origin (69 percent), and an additional 11 percent are of Central American origin.

Yet, what is also notable about those lacking a usual health care provider is the prevalence of Hispanics whose characteristics suggest assimilation. While most Hispanics who lack a provider are foreign born (70 percent), a full 30 percent were born in the 50 states. Half of those lacking a usual place for health care are citizens. A sizeable minority of immigrants who lack regular health care (45 percent) have lived in the United States for fewer than 10 years, but the majority (52 percent) have lived in the United States for 10 years or more.

On a similar note, a slight majority of those with no usual health care provider is English-dominant or bilingual (52 percent).

Finally, 45 percent of Hispanics who have no usual place for health care say they have health insurance.

So though health insurance is correlated with usual care, it does not guarantee it.

Of those Hispanics who have no usual place for health care, 45 percent have health insurance.

WHY DON’T PEOPLE HAVE A USUAL PLACE FOR HEALTH CARE?

The survey asked respondents who lacked a usual place to get medical care or advice why they did not have one.* By far the most commonly cited reason was  they felt they did not need one because they are seldom sick (41 percent). An additional 13 percent report they prefer to treat themselves than to seek help from medical doctors. The next most prevalent set of responses relates to finances: 17 percent report they lack health insurance, and 11 percent report the cost of health care prevents them from having a regular health care provider.

About 3 percent of Hispanics respond difficulties navigating the health care system are to blame for their lack of a regular provider: 2 percent report they do not know where to get regular health care, and about 1 percent reports they were unable to find a provider who spoke their language.

Finally, 3 percent say they prefer to go to a number of different health care providers, not just to one place, and 4 percent say they have just moved to the area, so presumably have yet to establish a relationship with a provider.

* Respondents who reported their usual health care provider was an emergency room were not asked this question.

QUALITY OF HEALTH CARE

While visiting a health care provider is important, the perceived quality of care received during health care visits is equally important. To assess the perceived quality of care, respondents who received any medical care in the past year were asked to rate care as “excellent”, “good”, “fair”, or “poor.”

More than three-quarters of Hispanics who have had medical care within the past year rate it as good to excellent: 32 percent say it was excellent, and 46 percent say it was good. At the other extreme, 17 percent say their care was only fair, and 4 percent report poor care.

FOLK HEALING

An overwhelming majority of Hispanics believe  sick people should obtain treatment only from medical professionals, but a small minority say they seek health care from folk healers. Those who receive care from folk healers are slightly more likely to be U.S.-born than foreign born and to speak mainly English, not Spanish.

Asked whether they obtain care from a curandero, shaman or someone else with special powers to heal the sick, 6 percent of Hispanics say they do and 10 percent report someone in their household receives such care.

About one in 12 Hispanics born in the 50 states use folk medicine, compared with one in 20 of those born in other countries or Puerto Rico. Similarly, one in 12 English-dominant Hispanics use folk medicine, as do one in 20 Spanish-dominant Hispanics. Hispanics of Cuban ancestry (11 percent) are more likely to obtain such care than other Hispanic groups. Hispanics without health insurance or a usual place for care are no more likely to seek folk care than those with health insurance or a usual place for care.

Most Hispanics (87 percent) say sick people should seek care only from medical professionals; only 8 percent say there is a role for folk medicine.

Opinions about this echo usage patterns to some extent. Hispanics who speak English (14 percent), as well as those born in the United States (12 percent), are the most likely to say there is a role for potions and folk healing. So are younger Hispanics, as well as those with at least some college education.

In general, more educated Hispanics, and those who have access to the medical system, give better evaluations of the quality of their medical care than do Hispanics with lower education levels, no insurance or no regular source of care.

Women are more likely than men to say their recent medical care was good or excellent, 80 percent to 74 percent. Eighty-one percent of the college-educated report being satisfied with their care, as compared with 75 percent of people lacking a high school diploma.

Among Hispanics with health insurance, 80 percent rate their care as good to excellent; among the uninsured, 70 percent do. Similarly, 80 percent of Hispanics who have a usual health care provider rate their care as good to excellent, compared with 64 percent who have no usual provider. Among those with a usual provider, Hispanics who usually get care in doctors’ offices give higher ratings than those who go to medical clinics.

Fully four in 10 who go to a doctor’s office rate their care as excellent, compared with 27 percent of those who get care from a clinic.

Generally, nativity and assimilation are not strongly associated with perceived quality of care. However, a mismatch between a Hispanic’s primary language and the language spoken at his or her appointment lowered the satisfaction ratings somewhat. For example, 30 percent of Spanish speakers whose appointments usually are conducted in English rate their care fair to poor, compared with 19 percent of those whose appointments are in Spanish.

Reasons for Poor Treatment

Respondents were also queried as to whether they had received poor service at the hands of a health care professional in the past five years. Those 23 percent who said they had received poor treatment were asked about four potential reasons. The largest share of Hispanics (31 percent) cited their inability to pay as the reason for poor treatment, followed by their race or ethnicity (29 percent), their accent or how they speak English (23 percent) and their medical history (20 percent).

Respondents who lacked health insurance, or a usual health care provider, were especially likely to claim  their inability to pay, their race, or their language skills contributed to their poor treatment. Forty-one percent of Hispanics with no usual place for health care, and 53 percent of Hispanics with no health insurance, reported their inability to pay contributed to poor treatment. In comparison, 27 percent of Hispanics with a usual provider reported as much, as did 20 percent of Hispanics with health insurance. Thirty-eight percent of Hispanics with no usual provider and 34 percent of those with no health insurance reported their race contributed to poor treatment by medical professionals, as compared to 25 percent of those with a usual provider and 26 percent of those with health insurance.

Thirty-two percent of Hispanics who lacked either health insurance or a usual provider reported their accent or poor English skills led to poor treatment, while 20 percent of the insured and those with a usual provider reported as much.

Other groups more likely than Hispanics overall to cite a lack of money as a reason for poor treatment include immigrants who aren’t citizens or legal permanent residents (45 percent), Spanish speakers (38 percent) and Hispanics who did not graduate from high school (41 percent).

Among the groups  are more likely than Hispanics overall to cite race as a reason they were treated poorly are Spanish speakers (36 percent), and noncitizens (38 percent of legal permanent residents and 35 percent of immigrants who are not citizens or legal permanent residents).

Among the groups most likely to cite language as the reason they received poor care are Hispanics with less than a high school education (37 percent), immigrants (33 percent) and those who mainly speak Spanish (43 percent).

Medical history is given as a reason for poor care by a somewhat higher share of older Hispanics (25 percent) and those whose primary language is Spanish (25 percent).

CHAPTER 3 - SOURCES OF INFORMATION ON HEALTH AND HEALTH CARE

While preventive care and regular health monitoring are essential in maintaining good long-term health and limiting the severity of chronic diseases, more than one in four Hispanics say they received no information regarding health or health care from doctors or health care professionals in the past year. This group includes a wide cross-section of the Hispanic population.

However, medical professionals are not the only ones providing health and medical information. Specific information regarding the importance of preventative care and regular health monitoring as well as the symptoms and treatment of chronic diseases can be delivered through alternate sources. Print and broadcast media, churches, community groups, family and friends, and the Internet are all sources of health and medical information for many Hispanics. Though the survey results do not address the validity or quality of the health information obtained through sources other than medical personnel, results do suggest  the information from these alternative sources has an impact on respondents’ behaviors.

Different sub-groups of Hispanics rely on different types of media. In general, U.S.-born Hispanics and those who have higher levels of education are more likely to get information in English from sources such as television, newspapers, magazines and the Internet. Immigrant Hispanics and those who have lower levels of education rely more on Spanish-language media, including television and print media, for information.

WHERE DO HISPANICS GET HEALTH CARE INFORMATION?

Respondents were queried as to how much information about health and health care they got from several different sources in the past year. For each potential information source, they could report getting “a lot” of information, “a little” information, or no information at all. Results show doctors and other medical professionals are the most common source of health and medical information for Hispanics, as they are likely to be for most groups. Nearly a third of Hispanics say they received a lot of health and health care information from doctors or other medical professionals over the past year, and 39 percent say they received a little information.

The second most important source of health information is television; 23 percent of Hispanics received a lot of information from TV and 45 percent received a little. Family and friends are next in rank: they supplied a lot of information to 20 percent of Hispanics and a little information to an additional 43 percent.

Radio, newspapers and magazines, and the Internet are also important sources of health care information.

Among Hispanics, 40 percent get health care information from the radio, 51 percent get some information from newspapers and magazines, and 35 percent get information from the Internet.

Churches and community organizations are another source of health information for many Hispanics. About one in three Hispanics (31 percent) say hey rely on the information they get from their churches and local community groups.

Question wording: How much information about health and health care did you get over the past year from a doctor or other medical professional, family or friends, the radio, the Internet, television, a church or community organization, newspaper or magazine?

Seventy-one percent of Hispanics received health information from a medical professional in the past year, but 83 percent got health or health care information from the media.

WHO GETS INFORMATION FROM THE MEDICAL COMMUNITY?

Hispanic women are more likely than are men to report getting health information from doctors and the medical community in the past year—77 percent report as much, compared with 66 percent of men. Overall, the age differences in receiving any information from medical professionals are not huge, but respondents ages 65 and older are more likely to have gotten a lot of health information from a professional (41 percent) than respondents under age 30 (28 percent).

As is the case with usual health care providers, those who are more educated and more assimilated are more likely to report exposure to the medical system.

People with at least some college education are almost 33 percent more likely to have gotten a medical professional’s advice than people lacking a high school diploma. Seventy-nine percent of Hispanics who speak primarily English and three-fourths of those who are bilingual report obtaining information from medical providers in the past year, while 62 percent of Spanish-dominant Hispanics have done so. Legal status is also correlated with the likelihood of obtaining health advice from a medical professional. Citizens born in the United States or Puerto Rico are most likely to have received medical advice (80 percent) from a professional, followed by naturalized citizens (70 percent), and legal permanent residents (64 percent). Fifty-nine percent of immigrants who are neither naturalized nor legal permanent residents reported obtaining health information from a medical professional.

Respondents of Puerto Rican (80 percent) and Cuban (78 percent) origin are especially likely to have received help from a medical professional in the past year. Conversely, Mexican-origin persons (69 percent) and Central Americans (69 percent) were less likely to report as much.

Question wording: How much information about health and health care did you get over the past year from a doctor or other medical professional, family or friends, the radio, the Internet, television, a church or community group, newspaper or magazine?

WHO GETS HEALTH INFORMATION FROM THE MEDIA?

While most Hispanics look to the medical community for answers to their health care questions, the media, and particularly television, also play a large role in providing health information. This role is especially important for Hispanics who do not typically utilize the health care system. Somewhat more than half (53 percent) of all Hispanics who lack a regular health care provider say they receive at least some information from doctors, but 64 percent of them say they get information from television. In contrast, among Hispanics who do have access to a usual place for their medical care, the relationship reverses: 78 percent say they get health information from the medical community, compared with 70 percent who say they get information from television.

This pattern is similar for Hispanics with and without health insurance. While 78 percent of Hispanics who have medical insurance get some information from doctors and other health care professionals, 69 percent say they get information from television. Conversely, while 59 percent of the uninsured say they get information from doctors, 68 percent obtain health information from television.

The use of television for health information is somewhat more prevalent among the foreign born and the less assimilated. Twenty-six percent of the foreign born report obtaining a lot of health information from this source in the past year, as did 19 percent of the native born. Twenty-seven percent of Spanish-dominant respondents reported obtaining a lot of information from television, compared with 18 percent of English-dominant respondents.

Information from doctors Information from TV

Television is the most pervasive media outlet, in terms of disseminating health information; 68 percent of respondents received information from television in the past year.

Question wording: How much information about health and health care did you get over the past year from a doctor or other medical professional? On television?

Radio also is an important source of health care information for Hispanics.

Radio’s role as an information source is roughly similar for Hispanics with a health care provider (39 percent) and those without one (42 percent). Likewise for Hispanics who have health insurance and those who do not—40 percent in both cases obtain health information from the radio.

Like television, radio as an information source is somewhat skewed toward immigrants and those whose primary language is Spanish. Thirty-five percent of English-dominant respondents get health information from the radio, compared with 42 percent of Spanish-dominant respondents. The results are similar when considering nativity. Thirty-five percent of the native born use the radio as a source for health information, compared with 42 percent of the foreign born. More than half of all Hispanics say they received a lot of information (14 percent) or a little information (37 percent) from print sources. Higher education levels, being native born and assimilation are all associated with higher likelihoods of retrieving health information from these print media. Forty-one percent of Hispanics with less than a high school diploma report getting information from newspapers or magazines, compared with 63 percent of people with at least some college education. Fifty-seven percent of the native born use print media, as do 47 percent of the foreign born. While 56 percent of English-dominant and bilingual Hispanics obtained at least some health information from these sources, the share drops to 42 percent among Spanish-dominant Hispanics.

Youth, education, nativity and assimilation are all strongly linked to Internet usage for Hispanics in general,15 and to the likelihood of using the Internet for health information in particular. Younger Hispanics use the Internet more than older Hispanics—42 percent of those ages 18 to 29 say they get information from the Internet, compared with 14 percent of those ages 65 and older.

The educational differences in the likelihood of getting health care information from the Internet are stark. While only 16 percent of Hispanics with less than a high school diploma and 36 percent of those with a high school diploma get information on health issues from the Internet, 63 percent of Hispanics who have at least some college education say they get a lot or a little information from the Internet. Hispanics born in the United States are twice as likely as are immigrants to get health care information from the Internet—52 percent versus 25 percent. English dominance, too, is strongly associated with using the Internet for health information; 53 percent of the English-dominant do so, compared with 17 percent of the Spanish-dominant.

WHO GETS HEALTH CARE INFORMATION FROM THE MEDIA IN SPANISH, AND WHO GETS IT IN ENGLISH?

Among Hispanics who receive any health-related information from television, 40 percent get information from only Spanish-language television stations, 32 percent from a mix of Spanish and English-language stations and 28 percent from only English-language stations. Similarly, among the Hispanics who use radio to obtain any of their health care information, 47 percent rely on Spanish language radio stations, 26 percent listen to Spanish and English-language stations and 27 percent rely on only English stations.

Women are more likely than men to get their health information in Spanish (44 percent versus 36 percent for television viewers, and 53 percent versus 43 percent for radio listeners). Age is also correlated with obtaining health information from Spanish-language broadcasts.

Thirty-eight percent of respondents younger than 30, and 48 percent of respondents ages 65 and older who got health information from television got it in Spanish. Similarly for radio listeners, 44 percent of those ages 18 to 29 and 54 percent of those ages 65 or older received their health information in Spanish.

Among those who watch television and those who listen to the radio, there is a strong association between educational levels and language use. In both cases, people with less than a high school diploma were more likely to get their information in Spanish (56 percent for television, 64 percent for radio) compared to those with at least some college education (17 percent for television, 20 percent for radio).

Question wording: Was the information mainly in Spanish or in English or in both languages?

More than half of respondents who get information from television or radio report getting information in Spanish, or in a mix of Spanish and English.

Of course, being native born and assimilated are associated with lower likelihoods of obtaining broadcast media health information in Spanish.

Most frequently, the information obtained from the Internet was solely in English (58 percent). However, 13 percent of respondents reported obtaining only Spanish-language Internet health care information. Twenty-nine percent of respondents got Internet health information in both English and Spanish.

The pattern is similar for newspapers and magazines. Hispanics who get some information from print media are most likely to read English-language newspapers and magazines (43 percent), though 27 percent read Spanish-only publications and 29 percent got health information from both Spanish and English publications.

Health Care Information from Social Networks

More than 60 percent of Hispanics report they received health information from their family and friends in the past year: 19 percent got a lot of information way, and 43 percent got a little. Immigrants are less likely to get information from family and friends (59 percent) than are native-born Hispanics (71 percent), plausibly because they have smaller networks of family and friends in the United States. Younger Hispanics are more likely to get information from family and friends than are older Hispanics—those ages 18 to 29 are 25 percentage points more likely to get information from family and friends than are Hispanics ages 65 and older.

Churches and community groups also play a role in providing health and health care information to Hispanics. Roughly 9 percent of Hispanics say they receive a lot of information from churches and community groups, and 22 percent say they receive a little information from these sources. There are few notable differences among demographic groups here. Around one-third of Hispanics with a high school education or less get information from churches and community groups, compared with 26 percent of people without at least some college education.

Another group relies more heavily on churches and community groups are Spanish-dominant respondents; 34 percent report obtaining health information from these sources, compared with 25 percent of English dominant Hispanics.

As such, it’s no surprise the information Hispanics received from churches or community groups was more likely to be in Spanish only (49 percent) or in both Spanish and English (31 percent) than only in English (19 percent). This is similar to the language of information obtained from the radio and quite distinct from of information obtained from the Internet, newspapers and magazines.

Seventy-nine percent of respondents who received health or health care information from the media acted upon information.

Health information provided by the media led 57 percent of Hispanics to ask a doctor or medical professional new questions. Six in 10 Hispanics who have a usual provider say this. So do nearly half of all Hispanics who do not have a usual provider. Hispanics whose primary language is Spanish are more likely to ask new questions to health care professionals as a result of media coverage than are English speakers, pointing again to the important role played by the Spanish language media.

The media even influence how some 41 percent of Hispanics make decisions on how to treat an illness or medical condition. Here, demographic differences among Hispanics are not great. Both those who have a usual provider (42 percent) and those who do not (38 percent) are nearly as likely to say  what they learned from the media affected how they think about treatment.

The Impact of the Media

Though the survey data do not allow for an evaluation of the appropriateness of the behavioral changes result from media exposure to health information, results clearly indicate alternative channels of health information have an effect on Hispanics’ behavior.

The media’s impact is strongest in producing reported changes in how Hispanics think about diet and exercise. Almost two-thirds of all Hispanics who received health and health care information last year from broadcast or print media, or from the Internet, say  what they learned changed the way they think about diet or exercise.

Younger Hispanics and women are more receptive to these types of changes than are older Hispanics or men. And while immigrants (69 percent) are more likely to say  health information from the television, radio, newspapers or the Internet led them to change how they think about diet and exercise, a majority of native-born Hispanics (56 percent) also report making changes in how they think about nutrition and physical activity because of what they learned from the media.

CHAPTER 4 – HOW MUCH DO HISPANICS KNOW ABOUT DIABETES?

According to the American Diabetes Association, millions of Americans are unaware they have diabetes. Although there is no cure for diabetes, people who know they have the disease often can keep it under control, and reduce the risk of serious side effects or death, through treatment that includes diet and medication.

Three-quarters (76 percent) of Hispanics know  there are effective treatments for diabetes  reduce the chances of death or serious side effects; the same share correctly say there is no medicine or treatment “ can permanently fix it.” A slightly lower share (72 percent) of Hispanics is aware maintaining a healthy weight is more helpful in preventing diabetes than avoiding all sugar. Seven in 10 Hispanics (71 percent) say correctly even people without a family history of diabetes have a risk of developing it.

These findings emerge from a battery of eight questions testing basic knowledge about the causes, symptoms and treatment of diabetes. Although most Hispanics do reasonably well (58 percent answered at least six questions correctly), a sizeable minority faltered on the test with nearly a third (32 percent) giving three to five correct answers and 10 percent scoring even lower. Among the less knowledgeable Hispanics are men, Spanish speakers and Hispanics who are foreign born. The best-informed Hispanics about diabetes are those with at least some college education, or with high levels of assimilation—U.S. citizens and long-term immigrants. Hispanics who have been diagnosed with diabetes score higher on the knowledge test than other Hispanics, but a As far as you know, is there a cure for diabetes, meaning there is a medicine or a treatment that can permanently fix it?

Once someone has been diagnosed with diabetes, do you happen to know whether there are effective treatments  will significantly reduce the chances of blindness, death or other serious complications?

What’s more helpful in preventing diabetes? (1) Avoiding all sugar (2) Maintaining a healthy weight.

If none of your relatives has a history of diabetes, do you have a risk of getting it yourself?

A notable share (27 percent) answered at least three of the eight questions wrong.

Having health insurance and a regular health care provider are both associated with more diabetes knowledge but they do not guarantee being well-informed.

Similarly, obtaining health information from medical personnel is associated with higher levels of knowledge but certainly does not guarantee them. Obtaining health information from some other sources is also associated with higher levels of diabetes knowledge. Respondents who report obtaining health information from family and friends and from print media, in particular, score better on the battery of diabetes knowledge questions.

Knowledge Differences by Demographic Group

There are notable differences by demographic characteristic in which Hispanics score high (six to eight correct answers), medium (three to five correct answers) or low (two or fewer correct answers) on a battery of eight questions testing basic diabetes knowledge.

About two-thirds of women (65 percent) correctly answer six or more questions, compared with half (51 percent) of men. Men also are more likely to get a low score, 13 percent compared with 7 percent of women.

The youngest and oldest Hispanics know less than those in the middle: 48 percent of those ages 18–29 and 65 and older score well, compared with substantial majorities of those ages 30 to 49 (63 percent) and 50 to 64 (68 percent). Among the oldest Hispanics, 15 percent score low, a larger share than for other age groups. There are differences across several demographic measures  point to greater knowledge by more assimilated, established Hispanics.

Looking at differences by education level, 13 percent of Hispanics who did not complete high school score low on diabetes knowledge, compared with 6 percent of those with at least some college education. Although half of Hispanics without a high school diploma score high, that compares with 70 percent of those with at least some college education.

Similarly, U.S.-born Hispanics are more likely to score high on diabetes knowledge (62 percent) than those who are foreign born or Puerto Rican (56 percent). When responses are analyzed by citizenship status, naturalized citizens are more likely to score high (60 percent) than are legal permanent residents (55 percent) or immigrants who are neither citizens nor legal permanent residents (48 percent). Among long-term immigrants, those who have been in the country for 15 years or more, 61 percent score high, compared with about half of shorter-term immigrants.

Nativity and assimilation are associated with higher levels of diabetes knowledge.

Examining differences by national origin, at least 14 percent of persons of Cuban, South American and Central American origin score low on diabetes knowledge, which is a larger share than for other groups. Central Americans (46 percent) and South Americans (47 percent) also have smaller shares of the highest-scoring respondents.

Knowledge Differences by Insurance Status and Health Care Access

Hispanics with health insurance are somewhat more likely to score high than those without insurance (61 percent versus 55 percent), but they are no less likely to get a low diabetes knowledge score than respondents with no insurance.

There are, however, differences between Hispanics with and without a usual source of care: 61 percent of those with a usual source score high, compared with 50 percent of those who have no usual provider. A higher share of Hispanics (14 percent) with no usual source of care scores low, as compared with Hispanics who do have a usual source of care (9 percent). Among those with a usual provider, the type of place where care is obtained also factors into diabetes knowledge. Respondents who visit a doctor regularly score better on diabetes knowledge questions than respondents who primarily visit clinics for their care; 65 percent score high, as compared with 57 percent of respondents who frequent clinics.

Knowledge Differences by Sources of Information

Hispanics who get a lot of health information from doctors are more likely to score high (65 percent) on diabetes knowledge than those who get little (59 percent) or no information (49 percent) from doctors. Those who get a lot of information from newspapers and magazines also are more likely to score high (69 percent) than those who get no information from those sources (50 percent). Those who get a lot of information from family and friends or the Internet also are more likely to score higher (62 percent and 71 percent, respectively) than those who do not (51 percent and 54 percent).

However, the gap in persons scoring high on diabetes knowledge is smaller when comparing respondents who report getting a lot of health information from television (59 percent) with those who report getting no health information from television (52 percent). The same is true for radio: 60 percent of those who get a lot of health information from radio score high, compared with 55 percent who get no health information from radio. Among those who get a lot of information from churches or community groups, a larger share scores low (58 percent) than high (52 percent).

Even when controlling for educational differences, the association between diabetes knowledge and use of certain information sources persisted. Hispanics who get a lot of information from doctors, family and friends, radio and print still scored better than those who do not.

When these responses are analyzed another way—comparing people who get at least some health information from any source with those obtaining no health information from any source—getting information is associated with better knowledge scores. One in four Hispanics who get no health information score low on diabetes knowledge, compared with one in 11 who get at least some information. Four in 10 of those who get no health information score high on diabetes knowledge, compared with six in 10 of those who get at least some information from any source.

Composition of the Low-Scoring Group

This section will look at the survey data on diabetes knowledge from another perspective:

The makeup of the low-scoring group. Although less educated and less assimilated Hispanics generally score lower on a test of diabetes knowledge, the least knowledgeable group also includes a notable share of higher-status Hispanics.

Nearly two-thirds of the low-scoring group (65 percent) are men. A third of the low scorers are ages 18–29, a slightly higher share (38 percent) are ages 30–49, 12 percent are ages 50–64, and the remaining 12 percent are 65 years and older.

Half of the group that knows little about diabetes consists of Hispanics who did not complete high school. High school graduates account for 27 percent and Hispanics with at least some college education make up 15 percent.

Foreign-born Hispanics account for more than seven in 10 of the low-scoring group. The foreign-born low-scoring group is split nearly evenly into citizens (20 percent of all low scorers), legal permanent residents (22 percent) and persons lacking citizenship or legal permanent residency (26 percent). Although Spanish speakers account for nearly half of low scorers (47 percent), one in five are English-dominant and one in three are bilingual. Most Hispanics who score low on the knowledge test about diabetes have health insurance (59 percent), and a usual place to go for medical care (63 percent).

About six in 10 of the low-scoring group (58 percent) say they get health information from medical professionals. The majority of Hispanics scoring low on the diabetes knowledge index have health insurance or a usual health care provider.

Diabetics’ Knowledge of Diabetes

Diabetics are more likely to know the basic facts about their condition than the general population does, but not all diabetics are well-informed: 73 percent score high on the knowledge test, 24 percent get a medium score and 3 percent get a low score.

Generally, diabetics have the same pattern of answers as the general population, but at higher levels of knowledge. For example, they are more likely to know blurry vision is a symptom (82 percent) than increased fatigue (69 percent). However, diabetics are no more likely than all Hispanics (76 percent) to know effective treatments are available to reduce the chances of blindness, death or other serious complications. Nor are they more likely to know maintaining a healthy weight is a better way to prevent diabetes than avoiding sugar intake (71 percent of diabetics are aware of this, as compared with 72 percent of non-diabetics).

With diabetics, as in the general population, the most educated and established Hispanics score the highest on a test of knowledge about diabetes. Eighty-six percent of diabetic Hispanics with at least some college education score high on the knowledge battery, compared with 71 percent of people lacking a high school diploma, and diabetics with regular care providers are more likely to score high (75 percent) than those without a usual place for care (66 percent).