Transcript Hispanic Population Growth and Health Care Access in Texas

Hispanic Health and
Health Care Issues in
Texas and the United
States
Karl Eschbach, Ph.D.
University of Texas Medical
Branch
Purpose
• To give a context for understanding
health care accessibility issues for
Hispanics in Texas and the United
States
Topics of remarks
1) Population growth
2) Composition of the Hispanic
population
3) Health status of Hispanics
4) Health care access
5) Regional burden in Texas
6) The undocumented population
Hispanics as percentage
of U.S. population, 19402004
15
10
5
0
1940 1950 1960 1970 1980 1990 2000 2004
Hispanics in Texas and
United States
• United States, 2004:
– 41.3 million;
– 14.1 %
• Texas, 2003:
– 7.6 million
– 34.2 %
Source: U.S. Census Estimates Program
Projected Hispanic Growth
to 2040, U.S. & Texas
Sources: U.S. Census Bureau; Texas State Data Center
Composition
• 86%+ of Texas Hispanics are Mexican
origin (U.S.=60%)
• 31% of Texas Hispanics are immigrants
(U.S.=40%)
• Hispanics have lower average education
• Concentration in service work, precision
production, craft, repair, construction and
transportation
Health status:
the Hispanic Paradox
• Low age-specific mortality rates for
the Hispanic population of the United
States compared to the non-Hispanic
White population despite socioeconomic disadvantage.
Mortality by Hispanic
Status (Sorlie et al JAMA 1993)
• Standarized mortality rate ratio for
Hispanics vs. Non-Hispanic Whites:
.74 men
.82 women
• Lower heart disease and cancer mortality
• Birth outcomes are similar to non-Hispanic
Whites
• Hispanic advantage is larger for immigrants
Cause of the mortality
advantage
• Better health behaviors
• Health selective migration
Implications
• Hispanics do not impose an
excessive health care burden
because of poor health habits, extra
burden of illness, higher use of
medical care
Limited access to health
insurance coverage
• Concentration in industries and
occupations with limited insurance
coverage.
• Unauthorized migration status limits
access to public programs.
Health Insurance, U.S.
Hispanics, 2003
Source: National Health Interview Survey, 2003
No health insurance, 2003,
National data
Source: National Health Interview Survey, 2003
Implications of lower
insurance coverage
• Lower rates of health care utilization
• Lower screening and immunization
rates
• Less likely to have a regular provider
of care
• Shorter survival after diagnosis
• Informal cross-border health care
utilization
Unauthorized immigrant
populations
• 80%+ of recent Mexican immigrants
are unauthorized
• 1.4 million in Texas, 10 million in U.S.
• 31 % of undocumented households
include citizen children
Source: Jeffrey Passel, Pew Hispanic Center
Implications
• Texas and the United States depend
on immigrant labor
• Neither employers or federal/state
government take responsibility for
paying for medical care
• Burden falls on the local hospital
districts and other providers and on
the immigrants
County of residence of
Texas Hispanics
Blue=U.S. Born
Red=Immigrants
Implications of regional
concentration
• Local concentrations of un-insured
immigrant populations in major
metropolitan centers burdens local
hospital districts.
• South Texas border communities
have low coverage rates despite
more native presence.
Conclusions
• Hispanics are a rapidly growing
population
• Hispanics are a relatively healthy
population
• Health insurance rates are far lower
• Health care access is impaired
• Burden on local health care providers
• Trends will magnify these problems if they
are not addressed