1. Hispanic Health and Health Care Issues in Texas and the United States Karl Eschbach, Ph.D. University of Texas Medical Branch

2. Purpose To give a context for understanding health care accessibility issues for Hispanics in Texas and the United StatesTo give a context for understanding health care accessibility issues for Hispanics in Texas and the United States

3. Topics of remarks 1) Population growth 1) Population growth 2) Composition of the Hispanic population 2) Composition of the Hispanic population 3) Health status of Hispanics 3) Health status of Hispanics 4) Health care access 4) Health care access 5) Regional burden in Texas 5) Regional burden in Texas 6) The undocumented population 6) The undocumented population

4. Hispanics as percentage of U.S. population, 1940-2004

5. Hispanics in Texas and United States United States, 2004:United States, 2004: –41.3 million; –14.1 % Texas, 2003:Texas, 2003: – 7.6 million –34.2 % Source: U.S. Census Estimates Program

6. Projected Hispanic Growth to 2040, U.S. & Texas Sources: U.S. Census Bureau; Texas State Data Center

7. Composition 86%+ of Texas Hispanics are Mexican origin (U.S.=60%)86%+ of Texas Hispanics are Mexican origin (U.S.=60%) 31% of Texas Hispanics are immigrants (U.S.=40%)31% of Texas Hispanics are immigrants (U.S.=40%) Hispanics have lower average educationHispanics have lower average education Concentration in service work, precision production, craft, repair, construction and transportationConcentration in service work, precision production, craft, repair, construction and transportation

8. 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 socio- economic disadvantage.Low age-specific mortality rates for the Hispanic population of the United States compared to the non-Hispanic White population despite socio- economic disadvantage.

9. Mortality by Hispanic Status (Sorlie et al JAMA 1993) Standarized mortality rate ratio forStandarized mortality rate ratio for Hispanics vs. Non-Hispanic Whites: Hispanics vs. Non-Hispanic Whites:.74 men.82 women.74 men.82 women Lower heart disease and cancer mortalityLower heart disease and cancer mortality Birth outcomes are similar to non-Hispanic WhitesBirth outcomes are similar to non-Hispanic Whites Hispanic advantage is larger for immigrantsHispanic advantage is larger for immigrants

10. Cause of the mortality advantage Better health behaviorsBetter health behaviors Health selective migrationHealth selective migration

11. Implications Hispanics do not impose an excessive health care burden because of poor health habits, extra burden of illness, higher use of medical careHispanics do not impose an excessive health care burden because of poor health habits, extra burden of illness, higher use of medical care

12. Limited access to health insurance coverage Concentration in industries and occupations with limited insurance coverage.Concentration in industries and occupations with limited insurance coverage. Unauthorized migration status limits access to public programs.Unauthorized migration status limits access to public programs.

13. Health Insurance, U.S. Hispanics, 2003 Source: National Health Interview Survey, 2003

14. No health insurance, 2003, National data Source: National Health Interview Survey, 2003

15. Implications of lower insurance coverage Lower rates of health care utilizationLower rates of health care utilization Lower screening and immunization ratesLower screening and immunization rates Less likely to have a regular provider of careLess likely to have a regular provider of care Shorter survival after diagnosisShorter survival after diagnosis Informal cross-border health care utilizationInformal cross-border health care utilization

16. Unauthorized immigrant populations 80%+ of recent Mexican immigrants are unauthorized80%+ of recent Mexican immigrants are unauthorized 1.4 million in Texas, 10 million in U.S.1.4 million in Texas, 10 million in U.S. 31 % of undocumented households include citizen children31 % of undocumented households include citizen children Source: Jeffrey Passel, Pew Hispanic Center

17. Implications Texas and the United States depend on immigrant laborTexas and the United States depend on immigrant labor Neither employers or federal/state government take responsibility for paying for medical careNeither 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 immigrantsBurden falls on the local hospital districts and other providers and on the immigrants

18. County of residence of Texas Hispanics Blue=U.S. Born Red=Immigrants

19. Implications of regional concentration Local concentrations of un-insured immigrant populations in major metropolitan centers burdens local hospital districts.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.South Texas border communities have low coverage rates despite more native presence.

20. Conclusions Hispanics are a rapidly growing populationHispanics are a rapidly growing population Hispanics are a relatively healthy populationHispanics are a relatively healthy population Health insurance rates are far lowerHealth insurance rates are far lower Health care access is impairedHealth care access is impaired Burden on local health care providersBurden on local health care providers Trends will magnify these problems if they are not addressedTrends will magnify these problems if they are not addressed