Access to Care

People in low socioeconomic classes are

• Less likely to have occupations that offer adequate health benefits;
• Less likely to have routine check-ups and health screenings because of money and time constraints. 
• More likely to receive lower quality care than their White counterparts and less likely to receive routine medical procedures, even among middle-class people of color.[1]

[1] BD Smedley, AY Stith, AR Nelson, eds. (2002), in: Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, A Report of the Institute of Medicine, Washington, DC: National Academy Press.

Linguistic Barriers

More than 20% of Americans speak a language other than English at home, and an estimated 24 million Americans speak English less than "very well." In California these figures are more dramatic, with 40% of the state's population speaking a language other than English at home.[1]  

In a 2002 study, 33% of Hispanics, 27% of Asian Americans, and 23% of African Americans reported communication problems with their physicians in comparison with 16% of whites.[2]  In addition, 26% of Latinos reported communication problems even when English was their primary language.[3]

A diverse workforce in the health professions will improve communication between the doctor and patient and create a more culturally competent health care system. Physicians of color are also more likely to serve communities of color and low-income communities in both rural and urban areas.

The Greenlining Institute produced a report as part of the California Medicare Part D Language access coalition that show that Medicare plans' call centers continue to fail to serve significant numbers of beneficiaries. Plan sponsors are able to serve limited English proficient dual eligible beneficiaries, after weighting for language prevalence among the dual eligible population, 69% of the time (up from 55% in 2006). Non-Spanish speaking LEP beneficiaries are connected to someone speaking their

language, after weighting, 57% of the time (up from 37% in 2006).

[1] U.S. Census Bureau. American Community Survey Estimates 2007. Accessed March 5, 2010:factfinder.census.gov.

[2] Collins KS, Hughes DI, Doty MM, et al. Diverse communities, common concerns: assessing health care quality for minority Americans. Findings from the Commonwealth Fund 2001 Health Care Quality Survey. New York, NY: Commonwealth Fund 2002.

[3] Ibid.

Literacy Barriers

According to US Health and Human Services’ Report, Healthy People 2010, health literacy is "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." The Pew Internet and American Life Project estimates that 61 percent of American adults look online for health information but maintain that Americans continue to turn to traditional sources of health information such as doctors, family, books, and insurance providers.

More revealing are the demographics of e-patients, adults who look online for information about health issues; 65 percent of non-Hispanic whites, 51 percent of African Americans, and 44 percent of Latinos use the internet for health information. These findings suggest that highly educated and wealthier Americans use the internet for health information at rates much larger than their lesser educated and lower income peers, providing valuable information about the ways in which technology is used to communicate health and wellness information, and the disparities between race/ethnicity, social class, and educational attainment.

The Uninsured

The majority of Americans receive their health insurance through their employers, with only a small percentage purchasing insurance on their own. The remainder of the insured receives coverage through government programs including Medicaid, the State Children's Health Insurance Program (SCHIP), Medicare, and military veteran's coverage.  This patchwork system of health care coverage is failing California's diverse communities. Of California's 6.6 million uninsured, 75% are communities of color.

Greenlining seeks to promote policies that will strengthen California's healthcare system so that all Californians will benefit, including policies that:

• Provide universal and affordable health care coverage for all Californians;
• Ensure equity of responsibility based on financial resources;
• Assure an efficient health care system to sustain universal coverage;
• Assure equitable, high quality health care for all, that includes cultural and linguistic competency; and
• Prioritize prevention by encouraging preventive care and creating healthy communities.

Related Publications

"Please Hold":  Medicare Plans Leave Limited English Proficient Beneficiaries Waiting for Access
Plans' call centers continue to fail to serve significant numbers of beneficiaries, showing only modest improvements compared to the 2006 survey results. In 2008 plan sponsors are able to serve limited English proficient dual eligible beneficiaries, after weighting for language prevalence among the dual eligible population, 69% of the time (up from 55% in 2006). Non-Spanish speaking LEP beneficiaries are connected to someone speaking their language, after weighting, 57% of the time (up from 37% in 2006).