Access to Care for US Latino Children in Traditional and Emerging Latino Communities

By | June 16, 2016

children-772275_960_720About one-quarter of all children born in the United States today are of Latino origin. Over the last twenty years, the under-18 US Latino population has grown rapidly – a result of both immigration and higher fertility rates among Latino adults relative to other groups.

The Latino population more than doubled in 9 states between 2000 and 2010, and all of those states were in the Southeast and Midwest.

While the majority of Latino children continue to live in communities near the Mexican border and major immigrant gateway cities such as New York and Chicago (“traditional” immigration destinations), the number of Latino children has grown most markedly in “emerging” immigration destinations, such as Charlotte and Indianapolis. The Latino population more than doubled in 9 states between 2000 and 2010, and all of those states were in the Southeast and Midwest (Figure 1).

FIGURE 1 . Defining traditional versus emerging immigration destinations. Source: Authors' analysis of Pew Hispanic data from 2000 and 2010 Census. Traditional destinations (N=141) have at least 20% population Latino in 2000. Emerging destinations (N=486) had <10% county population Latino in 2000, and the Latino population grew by at least 100% from 2000 to 2010. Medical Care: May 2016 - Volume 54 - Issue 5 - p 442–448 doi: 10.1097/MLR.0000000000000504

FIGURE 1 . Defining traditional versus emerging Latino communities. Source: Authors’ analysis of Pew Hispanic data from 2000 and 2010 Census. Traditional immigration destinations (N=141) have at least 20% population Latino in 2000. Emerging immigration destinations (N=486) had <10% county population Latino in 2000, and the Latino population grew by at least 100% from 2000 to 2010. Medical Care: May 2016 – Volume 54 – Issue 5 – p 442–448 doi: 10.1097/MLR.0000000000000504 (c) Walters Kluwer Health, Inc. All rights reserved.

In an article published in last month’s issue of Medical Care, Carole Roan Gresenz of the RAND Corporation and I examined the potential implications of this geographic shift for the health care experiences of Latino children. In particular, do the parents of Latino children who reside in emerging destinations report more health access challenges than in traditional destinations?

Dr. Gresenz and colleagues have previously found that living in an emerging destination was associated with significantly worse health access outcomes than living in a traditional destination among some Latino adults. Other studies have reported that services such as interpreters and culturally-competent care may be more difficult to obtain in communities where Latinos have not historically had a strong presence. 

How the study was conducted

Using geocoded data from the National Survey of Children’s Health – the largest health care survey on children in the US – we divided the study sample into children who resided in “traditional” communities, “emerging” communities, or neither. Our measures were based on the percentage of the county’s population identified as Latino as well as the percent change in the population from 2000 to 2010 (Figure 1).

Differences in communities

Emerging communities were somewhat more affluent than traditional communities – for example, they had a lower household poverty rate on average. They also had more health care resources, such as a greater supply of pediatricians in the population. We also found that the demographic characteristics of Latino children living in emerging communities were somewhat different than those in traditional communities. Latino children in emerging communities tended to be younger, in better health (as rated by their parents), to live with English-speaking parents, and to have private versus Medicaid insurance coverage.

Differences in health care access

We found that after adjusting for the demographic differences of the children and for factors like county affluence, there were relatively few differences in access to care or perceived quality of care between Latino children residing in emerging versus traditional communities. The one exception was having a usual source of care – in one of our regression models, we found that children in emerging communities were roughly 6 percentage points less likely to have a personal doctor or nurse.

Children in emerging communities were roughly 6 percentage points less likely to have a usual source of care – a doctor or nurse who provides continuity of care.

The relative lack of difference in access to care among children across communities is interesting, in part, because it indicates that the health care system may be operating differently for children than for their parents. One possibility is that better insurance coverage for children and different resources in pediatric care may be buffering against disparities in access that could otherwise arise. Another possibility is that the relative affluence of emerging communities may have a “protective” effect, compensating in some ways for the more culturally-tailored resources that would be available in traditional destinations. Differences in access reflect a wide array of factors as diverse as wait times in doctor’s offices, the cultural sensitivity of clinical staff, and proximity to public transportation. Differences in these factors across settings are important to understand and should be explored in further research.

Overall, however, our study also underscores some of the common challenges for Latino children – wherever they live. As a population, Latino children continue to have a higher uninsured rate and a lower rate of usual sources of care than do non-Latino counterparts. State and federal programs, such as Medicaid and community health centers, have helped to close this gap in recent years, but the challenges remain relevant to this diverse demographic.

Brendan Saloner is an assistant professor at the Johns Hopkins Bloomberg School of Public Health in the Department of Health Policy and Management. Dr. Saloner is interested in access to health services for vulnerable populations. He has previously published on the impact of federal and state health programs on insurance coverage, mental health services, and primary care. Dr. Saloner is the Greenwall Anniversary Fellow at the National Academy of Medicine in 2016-2017.

Latest posts by Brendan Saloner (see all)

Category: General Quality Tags: , , , ,

About Brendan Saloner

Brendan Saloner is an assistant professor at the Johns Hopkins Bloomberg School of Public Health in the Department of Health Policy and Management. Dr. Saloner is interested in access to health services for vulnerable populations. He has previously published on the impact of federal and state health programs on insurance coverage, mental health services, and primary care. Dr. Saloner is the Greenwall Anniversary Fellow at the National Academy of Medicine in 2016-2017.