Although Latinos make up the biggest racial or ethnic minority group in the United States, accounting for 18.7 percent of the population, we still face multiple barriers to accessible healthcare. Among them are language barriers, high medical costs, and cultural insensitivity.
The experiences of Josseline Morales’s family, who are originally from Guatemala but now live in Hempstead, New York, illustrate some of these challenges.
When Josseline’s mom informed her that her 10-year-old brother had been diagnosed with asthma, she was surprised. Even more shocking was that he’d been diagnosed seven months earlier, and Josseline’s mom had no idea.
When her mother told the doctor this was her first time hearing that her son had asthma, Josseline said the doctor bluntly told her mom, “This is why I don’t trust you people.”
According to the doctor, Josseline’s brother’s records showed a history of asthma and a prescription to manage it. But Josseline’s mom, who relied on a receptionist to translate information about her son’s diagnosis, was told that her son had a fever, and the prescribed inhaler was just temporary, until his breathing improved. [Editor’s note:One doctor consulted for this article says that such an incident should not have happened, because healthcare providers in New York have access to interpreter services over the phone.]
This type of situation is unfortunately not uncommon in America’s Latino community. In a survey by the Pew Research Center, 44 percent of Hispanic Americans said they believed that communication problems due to language or cultural differences were “a major reason” for worse health outcomes among Latinos.
While going to the doctor can be an intimidating experience for anyone, not being a native English speaker — or living in a culture that’s different from where you grew up — can make it even scarier. Here are some things to consider when seeking healthcare for yourself or a loved one.
Make an Appointment: It’s Vital to Your Health
Not seeing a doctor regularly can have consequences. Latinos in the United States have higher rates of obesity and infants with low birth weight than non-Hispanic white people — health issues that are often preventable and related to care access.
Latinos in particular may delay or skip seeing a doctor for a number of reasons, according to Diana E. Ramos, MD, MPH, the surgeon general of California and the first Latina to hold that position. One factor is that they may not receive educational messages — often delivered through English-language media — about the importance of prevention and screening for conditions like diabetes and cancer.
“Delaying the diagnosis, delaying the early care, really makes it so that Latinos oftentimes are diagnosed in a more advanced stage of disease,” says Dr. Ramos. “And when it’s more advanced, it’s harder to treat, it’s harder to get into remission.”
Sometimes a serious condition is diagnosed after a patient seeks care for an unrelated issue.
“We find people who’ve had diabetes for years, and they only find out when they come in for something else, like a respiratory infection,” says Jacqueline Beyer, RN, a family nurse practitioner at the Clinica Medica Hispana in Houston. “It’s not until we do blood work that we find their sugar levels are through the roof.”
One factor in delaying care, according to Ramos, may be cultural — a type of fatalism linked to religious beliefs. “Many times it’s the belief that, well, if God wants me to die, I’m going to die,” she says. “You know, I’m not going to go get that Pap smear, I’m not going to get that mammogram or prostate test.”
But this kind of fatalism, Ramos says, is really a form of denial — after all, health outcomes aren’t necessarily preordained, and they may be related to whether you get treatment early in the course of a disease.
Even if you don’t have any specific health concerns, it’s good to see a doctor regularly to review your health history, have a physical exam, and get any recommended tests. Most people ages 40 and older should see their doctor at least once a year for a checkup.
You Can Get Health Services With or Without Health Insurance
A significant barrier to healthcare is the price tag. Beyer says most of her patients work multiple jobs, many of which are not full-time. They may be working three part-time jobs, for example, and sending part of their earnings back to their home country to support their family. So paying hundreds of dollars for health insurance each month isn’t realistic when they’re already stretched financially.
In fact, Latinos have the highest uninsured rate of any racial or ethnic group in the United States, with 18.3 percent lacking health insurance in 2020 compared with 10.4 percent of Black, 5.9 percent of Asian, and 5.4 percent of non-Hispanic white Americans who lacked coverage, according to the U.S. Census Bureau.
The good news is that you don’t always need insurance to go to the doctor. Community health centers are a good option for low-cost care, since these nonprofit clinics provide routine care on a sliding scale based on your ability to pay. The federal government funds these clinics (also known as Federally Qualified Health Centers) directly, allowing them to provide care to underserved communities.
In addition, the Health Resources and Services Administration (HRSA) provides funding for similar programs — using a sliding scale based on your ability to pay — at migrant health centers, health centers for residents of public housing, and health centers for homeless people. An internet search for “community health center” can let you know about options in your area, including what services are offered.
If you qualify for insurance and have questions about enrolling or about your coverage, there are community health workers, also known as patient navigators, available. Navigators are hired by state governments, under the Affordable Care Act, to help people fill out applications for insurance. They are required to be unbiased when explaining options, and their services are free.
Before you make a doctor’s appointment, office managers and staff should be able to tell you whether the doctor accepts your insurance, and if there will be any copays.
Don’t Let Your Status Stop You From Getting Care
If you’re sick or injured, chances are you’ll want to see a doctor. Yet fear of deportation can make some immigrants hesitant to make a visit, and the increase in anti-immigrant rhetoric in recent years hasn’t helped. In fact, a study found that during the 2016 presidential campaign, primary care visits among undocumented immigrants went down for both adults and children — while emergency room visits for undocumented children went up at the same time, suggesting that many of them weren’t getting the preventive care they needed.
Existing policies can also act as barriers. The Affordable Care Act (ACA), for example, excludes undocumented immigrants from coverage through HealthCare.gov (the federal Marketplace) or state-run insurance exchanges. But you may qualify for coverage if you have, or have applied for, certain immigration status categories — including refugee, asylee, temporary protected status (TPS), and parole.
Regardless of your immigration status, you may purchase insurance outside the Marketplace, or get free or low-cost care at a community health center (or certain publicly funded health centers). Some states also offer insurance programs for children that don’t exclude undocumented children.
But many undocumented immigrants don’t see a doctor regularly due to policy barriers. As a result, many end up in emergency rooms — interventions that carry a hefty price tag and might have been prevented with a visit to a primary care doctor.
