Using data from a 1996/1997 survey of undocumented Latino immigrants in four sites, we examine reasons for coming to the United States, use of health care services, and participation in government programs. We find that undocumented Latinos come to this country primarily for jobs. Their ambulatory health care use is low compared with that of all Latinos and all persons nationally, and their rates of hospitalization are comparable except for hospitalization for childbirth. Almost half of married undocumented Latinos have a child who is a U.S. citizen. Excluding undocumented immigrants from receiving government-funded health care services is unlikely to reduce the level of immigration and likely to affect the well-being of children who are U.S. citizens living in immigrant households.

This DataWatch presents findings on Americans' ability to obtain health care. Data from the 1994 National Access to Care Survey sponsored by The Robert Wood Johnson Foundation suggest that earlier studies have underestimated the access problems facing Americans by not asking about supplementary services such as prescription drugs, eyeglasses, dental care, and mental health care or counseling. Using this more inclusive definition of health care needs, we estimate that 16.1 percent of Americans were unable to obtain at least one service they believed they needed. While income is highly correlated with unmet need, most persons reporting access problems are not poor.

Lack of health insurance is a major barrier to receiving medical care, even for highly serious and morbid symptoms.

OBJECTIVES: The purpose of this study was to examine how pharmaceutical expenditures vary by age and the presence of chronic health problems. METHODS: Data from the 1987 National Medical Expenditure Survey were used to obtain nationally representative estimates of outpatient prescription drug expenditures for the noninstitutionalized population and the fraction of total health expenditures used to purchase medications for age-chronic disease population subgroups. RESULTS: Although the elderly make up 12% of the population, they account for 34% of total pharmaceutical expenditures. Pharmaceutical expenditures are 9% of total expenditures for children, 13% for nonelderly adults, and 23% for the elderly. Among nonelderly adults, approximately one third have at least one chronic condition and account for over two thirds of drug expenditures. Among the elderly, 36% have three or more chronic conditions and account for 57% of drug expenditures for this group; 41% of total drug expenditures are for cardiovascular or renal drugs. CONCLUSIONS: Significant pharmaceutical spending is for treatment of chronic conditions, which subjects insurance coverage to adverse selection and could affect the design of prescription drug benefit packages. Current enrollees in Medicare risk management plans who have drug benefits may face significantly higher out-of-pocket expenses for pharmaceuticals if capitation rates are cut as a means of controlling Medicare program expenditures.

The passage of California's Proposition 187 in 1994 intensified debate over health care access for the undocumented population. Under Proposition 187, physicians would have been required to report the undocumented immigrants to immigration authorities. Even before 187, some undocumented may have been wary to come in contact with the medical care system. This paper examines whether concerns about one's immigration status serves as a deterrent to seeking care. These concerns may be resurfacing, with changes under the 1996 welfare reform legislation and related amendments that affect eligibility of non-citizen immigrants for public programs and states' ability to provide care to undocumented immigrants. Therefore, representative in-person surveys of undocumented Latinos were conducted in Houston, El Paso, Fresno, and Los Angeles in neighborhoods with significant concentrations of Latinos. It was found that 39% of the undocumented adult immigrants expressed fear about receiving medical services because of undocumented status. Those reporting fear were likelier to report inability acquiring medical and dental care, prescription drugs, and eyeglasses. Hence it can be concluded that concern about immigration status decreases the likelihood of receiving care.

Using the 1994 Robert Wood Johnson Foundation National Access to Care Survey, we examine the likelihood of having a usual source of care, inability to obtain needed care, and number of physician visits for persons with private insurance, Medicaid coverage, and no insurance. Inability to obtain services is surprisingly consistent: For each service, Medicaid enrollees were about half as likely as uninsured persons and about twice as likely as privately insured persons were to report difficulty. For other access measures, access for those on Medicaid more closely resembles that of the privately insured than that of the uninsured.

No abstract

Though HIV/AIDS has spread to rural areas, little empirical evidence is available on where patients living in these areas receive care. This article presents estimates of rural residents in care for HIV/AIDS, their demographic and health-related characteristics, information about whether they receive care in a rural or urban setting, and data on the drug therapies prescribed. The estimates come from the HIV Cost and Services Utilization Study (HCSUS), a nationally representative probability sample of HIV-infected adults receiving care in the contiguous United States. Regardless of the definition used--enrollment site, usual source of HIV care, or site of most recent hospitalization--almost three quarters of rural residents with HIV/AIDS obtained their health care in urban areas. The authors find that differences in the demographic characteristics of those using urban vs. rural care do not drive the decision on where to obtain care, with the primary difference being that people with a rural provider tend to be older. Rural residents with an urban usual source of HIV care incurred significant inconvenience in obtaining care--the majority said their care was not conveniently located, they had substantially longer mean travel times, and over 25% had put off obtaining care in the past 6 months because they did not have a way to get to their provider. Given the considerable burden this places on a chronically ill population,further research is needed to explore how provider supply and provider experience affect the decision to travel for care and how quality of care is affected.