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January 1999 Growing Hispanic Population Poses Major Health Care Implications by Lisa Baragar Katz, Consultant for Health Policy The arrival of 1999 has many people looking ahead to the next millennium and asking what it has in store. In the near term, the media warn of year-2000 (Y2K) technology bugs that threaten stock market crashes, airline catastrophes, public assistance payment and Medicaid and Medicare delays, and other related problems. For the long term, President Clinton, in his recent State of the Union address, warned that unless something is done soon, aging baby boomers will exhaust the federal Social Security fund by 2032. This same population threatens to flood the long-term care system, and the president offered a number of proposals, including tax breaks, to encourage people to save money now to pay for the care they will require later. Certainly, America’s changing demographics, particularly the aging of its citizens, has been a major topic of recent health care discussion and debate—especially since 1996, when the first wave of baby boomers turned fifty. Receiving substantially less attention, however, is another demographic trend: The changing racial and cultural composition of American society. Demographic Trends In 1996 the U.S. Census Bureau reported the following:1
Connie Marin, Community Coordinator of Special Projects for Ingham Regional Medical Center, works frequently with Lansing-area minority populations. She says that the health care implications of America’s changing demographics are considerable: “We can expect changes in health care financing, how policy is shaped, and how care is delivered.” Rising Costs Manuel Chavez, Ph.D., is Assistant Director for the Center for Latin American and Caribbean Studies (CLACS) and a faculty-member of the Julian Samora Research Institute for the Hispanic Midwest, both at Michigan State University. He explained that the nation’s growing Hispanic population has important cost implications for the health care system. For example, as recently as one year ago, Mexicans had the lowest naturalization rate of all immigrant groups. Because they were not U.S. citizens, many who resided here were not eligible for most American public assistance programs. Then, in 1997, the Mexican government amended its constitution to allow its people dual citizenship. During the policy’s first year, more than three million Mexicans living in the United States applied to become citizens, and they will not have to relinquish their Mexican citizenship once they are naturalized. Dr. Chavez also explained that, as new American citizens, Mexicans will have full access to programs like Medicaid and Medicare, and with more people eligible, the programs will become more expensive to operate. Compounding this problem, added Marin, are the changing emigration policies of South American countries, like Nicaragua and the Dominican Republic, that have been affected by natural disasters, including severe flooding and mud slides. She explained that these nations are allowing many of their citizens to relocate voluntarily to other countries, and the United States is cooperating. Almost 97 percent of those who have opted to emigrate have chosen to move to the United States, and many likely will become eligible for public health care programs. Cultural Competence Another health care issue stemming from the nation’s changing demographics, particularly the increasing number of Hispanics, is the ability of physicians, health care facilities, and insurers to communicate with and otherwise understand patients. For example, in a 1998 random sampling of 2,000 physicians, the Association for Health Services Research found that 80 percent are non-Hispanic whites, while 11 percent, are Asian/Pacific Islander, 4 percent are Hispanic, and 3 percent are black. The remaining 3 percent of the sample indicated their race/culture as “other” or “unsure.” Marin commented that not many health care providers speak Spanish or understand Hispanic culture. “Even those of Hispanic origin often do not fully understand [these things].” She suggested that policymakers and the health care industry join forces to educate providers about and address cultural awareness. Some states (e.g., California, Illinois, and Massachusetts) have adopted laws that address the matter by requiring health care providers and facilities to hire interpreters. The State of Washington goes so far as to hold physicians liable for malpractice if they fail to provide proper medical interviews because of language barriers. Also, many organizations are responding to the need for cultural competency among health providers by performing cultural competency assessments, for example, through focus groups and surveys of facilities’ service offerings. Others have developed curriculum guidelines outlining methods for achieving quality cross-cultural care, and some have created videos and handbooks to educate physicians. Another concern shared by Chavez and Marin is physicians’ understanding of the health care problems that affect different minority populations. For example, compared to whites and Asians, blacks and Hispanics are particularly vulnerable to diabetes and hypertension. “Many problems associated with these diseases could be avoided if patients knew and providers could explain more about the effects of their ethnic diets, which often are high in fat, salt, and carbohydrates,” contended Marin. Others observe that it is difficult to get statistical information about minorities and health. For example, Michigan’s Health Statistics Report, which is distributed annually to the public, provides vital health information, including birth and death rates, on the state’s population. The data are broken down by “white,” “black,” and “other.” Although state officials point out that information concerning culture and race is available if requested, some argue that the distributed report should include more specific information. Finally, Marin stated, the burden of cultural understanding should not rest with providers alone: “Minority cultures also must work to understand the majority culture. Both sides must make an effort.” She said that one of the most effective steps that physicians and hospitals can take is hiring people who represent the communities they serve. Conclusion Chavez pointed out that the Hispanic population will grow more in the next 15–20 years in states like Texas, California, and Florida, than it will in Michigan, but all states will feel the effects of changing demographics. “The question is the extent to which policymakers respond to these changes. They must realize that not only will their constituency consist of many minorities, but so will their competition.” Chavez and Marin believe that the best way for minorities to affect health care policy is to run for public office themselves. |
