[News release] Insuring undocumented residents could help solve multiple U.S. health care challenges

From the 18 March 2015 UCLA news release

UCLA health care policy analysis finds four key problem areas for Latinos under Affordable Care Act

Latinos are the largest ethnic minority group in the United States, and it’s expected that by 2050 they will comprise almost 30 percent of the U.S. population. Yet they are also the most underserved by health care and health insurance providers.

Latinos’ low rates of insurance coverage and poor access to health care strongly suggest a need for better outreach by health care providers and an improvement in insurance coverage. Although the implementation of the Affordable Care Act of 2010 seems to have helped (approximately 25 percent of those eligible for coverage under the ACA are Latino), public health experts expect that, even with the ACA, Latinos will continue to have problems accessing high-quality health care.

Alex Ortega, a professor of public health at the UCLA Fielding School of Public Health, and colleagues conducted an extensive review of published scientific research on Latino health care. Their analysis, published in the March issue of the Annual Review of Public Health, identifies four problem areas related to health care delivery to Latinos under ACA:

• The consequences of not covering undocumented residents.
• The growth of the Latino population in states that are not participating in the ACA’s Medicaid expansion program.
• The heavier demand on public and private health care systems serving newly insured Latinos.
• The need to increase the number of Latino physicians and non-physician health care providers to address language and cultural barriers.

“As the Latino population continues to grow, it should be a national health policy priority to improve their access to care and determine the best way to deliver high-quality care to this population at the local, state and national levels,” Ortega said. “Resolving these four key issues would be an important first step.”

Insurance for the undocumented

Whether and how to provide insurance for undocumented residents is, at best, a complicated decision, said Ortega, who is also the director of the UCLA Center for Population Health and Health Disparities.

For one thing, the ACA explicitly excludes the estimated 12 million undocumented people in the U.S. from benefiting from either the state insurance exchanges established by the ACA or the ACA’s expansion of Medicaid. That rule could create a number of problems for local health care and public health systems.

For example, federal law dictates that anyone can receive treatment at emergency rooms regardless of their citizenship status, so the ACA’s exclusion of undocumented immigrants has discouraged them from using primary care providers and instead driven them to visit emergency departments. This is more costly for users and taxpayers, and it results in higher premiums for those who are insured.

In addition, previous research has shown that undocumented people often delay seeking care for medical problems.

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As the ACA is implemented and more people become insured for the first time, local community clinics will be critical for delivering primary care to those who remain uninsured.

“These services may become increasingly politically tenuous as undocumented populations account for higher proportions of clinic users over time,” he said. “So it remains unclear how these clinics will continue to provide care for them.”

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[Press release] Distrust of police is top reason Latinos don’t call 911 for cardiac arrest

Distrust of police is top reason Latinos don’t call 911 for cardiac arrest.

From the 4 December 2014 EurkAlert

WASHINGTON – Fear of police, language barriers, lack of knowledge of cardiac arrest symptoms and financial concerns prevent Latinos – particularly those of lower socioeconomic status – from seeking emergency medical help and performing cardiopulmonary resuscitation (CPR), according to a study published online yesterday in Annals of Emergency Medicine (“Barriers to Calling 911 and Learning and Performing Cardiopulmonary Resuscitation (CPR) for Residents of Primarily Latino, High-Risk Neighborhoods in Denver, Colorado”).

English: CPR training (Photo credit: Wikipedia)

“Residents of low-income, minority neighborhoods have two strikes against them: the incidence of out-of-hospital cardiac arrest is much higher than average and rates of bystander CPR are below average,” said lead study author Comilla Sasson, MD, PhD, FACEP of the American Heart Association and the University of Colorado School of Medicine in Aurora, Colo. “We need to do a better job of overcoming the significant barriers to timely medical care for Latinos suffering cardiac arrest. Culturally sensitive public education about cardiac arrest and CPR is a key first step.”

Researchers conducted focus groups and interviews with residents of primarily lower-income Latino neighborhoods in Denver to determine why they underutilize 9-1-1 emergency services and how to increase knowledge and performance of CPR on people suffering cardiac arrest. General distrust of law enforcement, of which 9-1-1 services are bundled, was cited as a top reason for not calling 9-1-1 by most participants.

Many subjects also believed – incorrectly – that they would not be able to ride an ambulance to the hospital without first paying for it, as that is the practice in Mexico where many participants came from. Subjects also expressed a lack of understanding about the symptoms of cardiac arrest and how CPR can save a life. Strong reticence about touching a stranger for fear that it might be misconstrued was a unique cultural barrier to performing CPR. Language barriers – either with 9-1-1 dispatchers or first responders – also inhibited subjects from getting involved with someone experiencing cardiac arrest.

In the interest of educating more people on how to perform CPR, participants widely supported policy changes that would make CPR either a high school graduation requirement or a pre-requisite for receiving a driver’s license.

“Future research will need to be conducted to better understand how targeted, culturally-sensitive public education campaigns may improve the provision of bystander CPR and cardiac arrest survival rates in high-risk neighborhoods,” said Dr. Sasson.

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Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information, visit http://www.acep.org.

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How Smartphones Could Impact Public Health

(Chart via Pew.)Smartphone owners now outnumber regular cell phone owners for the first time, according to a new study.

From the March 3, 2012 article in the Boston Globe

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This smartphone proliferation has tremendous potential from a public health perspective. When Ispoke with Frank Moss at Bluefin Labs for the story, he described a day when doctors would simultaneously prescribe medicine with an app to help patients better monitor their care (you can read more of Moss’s ideas about mobile health in his New York Times op-ed). When you consider that smartphone penetration is already higher in African American and Latino communities (49 percent in each group vs. a national average of 46 percent) and that these two groups are historically disadvantaged when it comes to accessing health care (just browse the February headline roundup from the Kaiser Family Foundation for examples of these disparities), it would be revolutionary to begin targeting health care apps and devices to these populations.

When we consider looking that the gadgets being pushed into the marketplace to help us monitor our health (many of which I tried while reporting the story) we forget that they’re all targeting ”fairly affluent people,” says Jane Sarasohn-Kahn, a health economist who often blogs about public health at Health Populi. “When we look at the burden of chronic disease, it’s the African Americans and Latinos, the poor and less-educated, and very old or very young that don’t have access to healthy food or safe places. These populations have spent as much money on their mobile phones [as the rest of the country], but the platform technology hasn’t penetrated into poor urban areas.”

Sarasohn-Kahn hopes that Medicaid will start developing applications to target these populations, and points to the recent move by a former CDC scientist to develop an asthma inhaler outfitted with GPS and Wifi enabled sensors. When distributed in urban populations, the inhalers allow the doctors to better track their patients, and allow epidemiologists to learn more about the health of these groups. Right now, the smartphones are spreading at a rapid clip through the country. We just need to be smart enough to know how to help them nudge us all toward better health….