Economic factors contribute to a large proportion of the disparities seen between Hispanics and the general U.S. population in the management of ESRD and its risk factors. In particular, lack of health insurance represents a major barrier to healthcare. Data from the Health and Retirement Survey revealed extremely low levels of insurance coverage among Hispanics, especially Mexican Americans. In a study of patients with ESRD across the United States between 1995 and 1999, 13% of Hispanic Mexicans and 9% of other Hispanics did not have medical coverage, compared with 7% of non-Hispanics.

Patients who are without medical insurance are not only less likely to seek medical care but may also be less frequently referred for procedures and other services than those who are insured. In a survey assessing quality of care, it was shown that 43% of Hispanics compared with 20% of whites were without a regular doctor, and this resulted in a dependency on safety-net facilities. In fact, 7% of the Hispanic community have no regular source of healthcare, or use the emergency room as their regular source of care. Moreover, insurance policies often provide insufficient funding for expensive treatments—a factor that is further aggravated by the higher proportion of financially disadvantaged patients in the Hispanic community, compared with whites. Hispanics are not a homogeneous population. For example, Puerto-Rican Americans are almost two times more likely than Mexican Americans and over four times more likely than Cuban Americans to be covered by Medicare. Cuban Americans are most often privately insured and, of the three main Hispanic subgroups, Puerto-Rican Americans are most likely to attend at least one physician visit and show the highest level of service use.
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Hispanics are less satisfied than the general white population with physician visits. In one study, it was reported that both the quality of examinations and the reassurance and support offered by doctors to Hispanics were significantly poorer than for the general white population. Differences in satisfaction ratings arose from actual differences in experiences rather than measurement bias.

Hispanics, especially those with lower incomes, face many barriers in access to all types of healthcare, especially highly specialized procedures, such as transplants. Another explanation for the relatively low transplant rate among Hispanic diabetic patients may be that problems with citizenship status may preclude some patients from being listed in the UNOS registry. Other possible barriers to transplantation may include high mobility, especially among migrant and immigrant families. All of these factors may also impact negatively on Hispanics’ access to dialysis or transplant procedures.
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Problems of access to care are compounded by a lack of physician understanding of cultural and socioeconomic issues relating to the Hispanic population. This lack of awareness leads to inadequate efforts by physicians to overcome cultural or religious barriers to essential medical care.

Even basic concepts regarding illness differ among racial groups. Among the general American population, good health is seen as a universal right. Among some Hispanics, illness may be viewed as an imbalance of the body due to fate, heredity, bad luck, wrongdoing, or other factors.

In many Hispanic groups, decisions about healthcare may be made by older female relatives, and home remedies tried before visiting a physician.

Patients who have chronic conditions that cannot be cured may feel that the western physician does not know how to treat them, and so they may turn to a folk healer.

Religion also plays a major role, with ritual practices, such as visiting shrines and praying, being included in the treatment process. Mexican Americans may seek professional medical care only when self-treatment and folk-healing practices have failed.

Communication Barriers

Ways of communicating that are normal for the general U.S. population, such as plain-speaking, openness, and direct gaze, are not employed by Hispanics. Directness and bluntness are considered rude by Hispanics, who instead value diplomacy, tact, and respect for others. The use of first names represents overfamiliarity, and personal matters are not generally discussed with strangers.
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Language is a critical barrier, and patients are often unable or unwilling to communicate to their physician that they do not understand or speak English well enough to explain their symptoms or understand their diagnoses. Regardless of language skills, Hispanics are more likely to report difficulties in communicating with and understanding their doctor than the rest of the population: 33% of Hispanics report having communication difficulties with their physician, a figure that rises to 43% in Spanish-speaking Hispanics, compared with just 16% of whites. Among insured, elderly adults, Spanish-speaking Hispanic patients are significantly less likely to visit a physician than non-Hispanic white patients. Spanish-speaking Hispanics are also less likely than English-speaking Hispanics to have a usual source of healthcare and are consequently less likely to see a physician or have their blood pressure checked.

Category: Cancer / Tags: culture, healthcare policies, Hispanics, risk factors

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