Embed Size (px)
Citation preview
1
Lynn A. Blewett, Ph.D.Assistant Professor
Tracy L. Johnson, Ph.D.President, Health Policy Solutions
Adjunct Faculty, University of Colorado
Timothy Beebe, Ph.D.Senior Research Associate
Gestur Davidson, Ph.D.Senior Research Associate
Kathleen Call, Ph.D.Associate Professor
Division of Health Services Research and PolicyUniversity of Minnesota, School of Public Health
Assessing Health Insurance Coverage of Latinos with
Limited English Proficiency (LEP)
American Public Health Association Annual Meeting
November 18, 2003
2
Research Questions
1. Controlling for other variables, do Latinos with Limited English Proficiency (LEP) have lower rates of health insurance coverage than Latinos with English proficiency? -- Is language a key barrier?
2. Do the rates of health insurance coverage for Latinos with English proficiency approach the coverage rates for non-Latinos?
3. Do trends hold across two different states: Minnesota and Colorado?
3
Definition of LEP
Limited English Proficiency
“Sometimes called ‘English Language learners’ (ELL), [individuals
with limited English proficiency] cannot speak, read, write or
understand English well enough to effectively communicate in
English. This means that they may have difficulty communicating
with health care providers and social service agencies.”Source: Minnesota Medical Association http://www.mnmed.org/pdf/proficiency.PDF
Operational definition for study: Latinos who requested and
answered the health insurance survey questions in
Spanish
4
Minnesota and Colorado Uninsured Rates by Race/Ethnicity
Race/Ethnicity Minnesota Colorado
STATEWIDE RATE 5.4% uninsured 11.7% uninsured
NON-LATINO WHITES 4.6% uninsured 9.1% uninsured
LATINO RATE 17.4% uninsured 22.4% uninsured
Source: Minnesota Health Access Survey (2001); Colorado Household Survey (2001)
5
Descriptive Statistics for Latino’s with LEP
Latinos with Limited English Proficiency:- are more likely to have poorer health, - are less likely to be employed, - are more likely to be poor, and - are more likely to be uninsured.
As compared with Latinos with English proficiency and with non-Latino whites.
Data Sources: Minnesota Health Access Survey (2001); Colorado Household Survey (2001)
6
Minnesota and Colorado Latino Uninsured Rates by LEP Status
(Adults19-64 years)
Race/Ethnicity Minnesota Colorado
LATINOS w/ LEP 42.2% uninsured 50.9% uninsured
LATINOS w/ English Proficiency 13.8% uninsured 16.3% uninsured
Source: Minnesota Health Access Survey (2001); Colorado Household Survey (2001)
7
Isolating the Impact of Language
• Difficult to isolate the impact of language on access to care– Latinos have lower rates of health insurance coverage
which is associated with lower access. It might not be language per se…
• LEP is correlated with other explanatory variables in relation to health insurance access– Income, employment status, years in the country,
access to employer-sponsored coverage– Again confounding with health insurance coverage
8
2001 Minnesota Health Access Survey
Colorado Household Survey (2001)
• RDD telephone survey: English, Spanish. (Hmong: Minnesota)
• Two stage design: selected random individuals within random households
• Statewide stratified probability sample:– over-sampling non-metro regions – among populations of color
• MN Sample size = 27,315 (Adult 19-64 Latino = 535)• CO Sample size=10,217 (Adult 19-64 Latino = 1406)• Collected point-in-time coverage for all HH members
9
Methods
Multivariate Logistic Regression / Method of Recycled Probabilities
Populations:
(1) Latinos with Limited English Proficiency
(2) Latinos with English Proficiency
(3) Non-Latino Population (all the rest)
Dependent Variable:
Health Insurance Coverage = Yes/No
Other Explanatory Variables:
Age, Gender, Income, MSA, Health Status, Marital Status, Employment Status, More than one job, Education
States: Colorado, Minnesota (separate regression models)
10
MINNESOTAPercent Uninsured at Time of Survey
(Adults 19-64)Unadjusted
(%)
Adjusted(%)
% Difference
LEP 42.20 18.41 56%
Non-LEP 13.75 9.30 32%
Non-Latino 6.18 6.24 .01%
11
COLORADOPercent Uninsured at Time of Survey
(Adults 19-64)Unadjusted
(%)
Adjusted(%)
% Difference
LEP 50.8 25.7 49%
Non-LEP 16.3 12.9 21%
Non-Latino 11.9 13.0 -9%
12
MINNESOTADifference in Uninsured Rates – Adults
Unadjusted Adjusted
LEP vs.
Non-LEP
28.45%
(p=.000)
9.11%
(p=.036)
LEP vs. Non-Latino
36.02%
(p=.000)
12.17%
(p=.004)
Non-LEP vs.
Non-Latino
7.56%
(p=.001)
3.06%
(p=.067)
13
COLORADODifference in Uninsured Rates – Adults
Unadjusted Adjusted
LEP vs.
Non-LEP
34.6%
(p=.000)
12.7%
(p=.052)
LEP vs. Non-Latino
40.0%
(p=.000)
12.8%
(p=.046)
Non-LEP vs.
Non-Latino
4.4%
(p=.044)
.01%
(p=.96)
14
Conclusions/Policy Implications
• Measuring coverage across all Latinos masks underlying disparities, (e.g., LEP vs. non-LEP)
• Policies and programs need to respond to identified subgroup differences
• While language is important, much of the effect goes away when you control for other key variables: income, education, employment, etc….
• More services and information in Spanish for new arrivals to facilitate access to health insurance coverage
• Employment and education are equally important to facilitating access to coverage
15
SHADAC Contact Information
www.shadac.org2221 University Avenue, Suite 345
Minneapolis Minnesota 55414
(612) 624-4802
Principal Investigator: Lynn Blewett, Ph.D. ([email protected])
Co-Principal Investigator: Kathleen Call, Ph.D. ([email protected])
Senior Research Associate: Gestur Davidson, Ph.D. ([email protected])
Senior Research Associate: Timothy Beebe, Ph.D. ([email protected])
Consultant: Tracy L. Johnson, Ph.D. ([email protected])
