Disparities for Latino Children in the Receipt of

Timely Medical Care

David Brousseau MD, MS, Jennifer Yauck MS,

Raymond Hoffmann PhD, Ann Nattinger MD, MPH,

Glenn Flores MD

Background

• Latino children: population– Largest minority racial/ethnic group = 16%– California: largest racial/ethnic group

• Latino children: health– Sub-optimal health status– Fewer physician visits– Lack health insurance– Less likely to have primary care provider

• Effect on quality of care ?

Latino quality of care

• Adherence to accepted standards– Lower likelihood of vision screening– Decreased use of inhaled steroids

• Self/Parent reported quality of care– No studies specifically looking at children– No studies controlling for confounders

Objective

• To compare the parent-reported ability of children to get timely medical care among Latino, White and African-American children

Methods

• Population: – 2000 Medical Expenditure Panel Survey

(MEPS)– Children < 18 years of age with a usual

source of care

• All analyses weighted to represent national averages

Methods

• Timely medical care– 1) Timely routine care from a provider– 2) Timely illness or injury care from an office, clinic

or ED– 3) Phone help from a provider– 4) Brief wait time with an appointment

• Scoring– 4 point Likert scale, except Brief wait time

Methods: Analysis

• Primary outcome measure: – Not receiving the highest quality

primary care• Always receiving timely medical care• Shortest waits for Brief wait time

• Univariate analysis by race/ethnicity– Analyzed using Chi-square

Methods: Multiple regression

• Latinos as the referent group

• Adjusted for:– Age, sex, health status, special health care

needs– Insurance type, highest education

• With and without language in model

• Odds ratios

Results

• 4,120 children– Weighted to represent 47 million children – Average age: 8 years– 51% male

Results: Unweighted

30%17%

53%

LatinoWhiteAfrican American

24%11%

65%

PublicPrivateUninsured

Race/ethnicity Insurance

Results: Univariate analysis

Latino White African-

American

Routine care * 56% 46% 46%

Illness/injury care 39% 34% 36%

Phone help * 60% 51% 53%

Brief wait time * 64% 45% 56%

* P < 0.005

Results: OR for Latinos compared to Whites

Without language

95% CI With language

95% CI

Routine care

1.28 1.04-1.56 1.19 0.95-1.50

Illness care 1.04 0.79-1.39 0.88 0.64-1.20

Phone help 1.37 1.16-1.62 1.28 1.07-1.54

Brief wait time

1.96 1.66-2.32 1.65 1.38-1.99

Results: OR for Latinos compared to African-Americans

Without language

95% CI With language

95% CI

Routine care

1.48 1.15-1.98 1.38 1.04-1.82

Illness care

1.09 0.75-1.61 0.90 0.60-1.36

Phone help

1.29 1.05-1.58 1.20 0.96-1.50

Brief wait time

1.43 1.16-1.76 1.19 0.95-1.49

Conclusion

• Latino children experience marked disparities in obtaining timely medical care

• The disparities are only partially explained by language differences

• Improvements are needed in the delivery and efficiency of medical care for Latino children