1. 1 Ethnic Disparities in SCHIP: The Role of Acculturation Susan G. Haber, Sc.D. Janet B. Mitchell, Ph.D. Sonja Hoover, M.P.P. (presenting) RTI International June 6, 2004 411 Waverley Oaks Road Suite 330 Waltham, MA 02452 Tele: 781-788-8100  FAX: 781-788-8101 This research was funded by the Agency for Healthcare Research and Quality (AHRQ), the David and Lucile Packard Foundation, and the Health Resources and Services Administration (HRSA) under the Child Health insurance Research Initiative (CHIRI).

2. 2 Overview n Nearly one-third of SCHIP population in Oregon is Hispanic l 71% of Hispanic parents do not speak English at home l 55% of Hispanic children do not speak English at home n Research questions: l Do Hispanic children differ from non-Hispanic children? l Are these differences explained by acculturation (as measured by language)?

3. 3 Methods n Telephone survey of parents of children enrolled in OHP’s SCHIP n Oversampled parents of Hispanic children n Conducted in both English and Spanish in 2002 n Included both currently enrolled, and recently disenrolled, children n N= 1,206 n Response rate=53%

4. 4 Characteristics of SCHIP Children Hispanic Spanish- speaking (%) English- speaking (%) Non-Hispanic (%) Child’s age (in years)** 0-532.029.019.1 6-1254.054.448.4 13-1814.016.632.5 Two parent family 78.1 *,† 55.355.9 At least one-parent employed full-time 87.6* 82.6*69.8 Parent is high school graduate 22.3 *,† 85.483.8 Parent born outside US 94.0 *,† 10.3 8.4 *Statistically different from non-Hispanic children at <0.05 level. † Statistically different from English-speaking Hispanic children at <0.05 level.

5. 5 There is mixed evidence on health status for children in Spanish-speaking families *Statistically different from non-Hispanic children at <0.05 level. † Statistically different from English-speaking Hispanic children at <0.05 level. Hispanic Spanish- speaking (%) English- speaking (%) Non-Hispanic (%) General health status is excellent/ very good 51.7 *,† 76.574.1 Special health care needs (based on LWI screener) 12.0 *,† 25.230.5

6. 6 A high percentage of children in Spanish-speaking families used a clinic as their USC Hispanic Spanish- speaking English- speakingNon-Hispanic % with usual source92.5 † 98.394.9 Location of usual source (% distribution): *,† Community health center48.916.115.0 Hospital clinic32.720.313.6 Doctor’s office or HMO14.263.369.7 Emergency room 4.2 0.4 1.6 Child sees a particular doctor at this place (%) 68.0 *,† 88.484.7 *Statistically different from non-Hispanic children at <0.05 level. † Statistically different from English-speaking Hispanic children at <0.05 level.

7. 7 Children in Spanish-speaking families had less service use (% within past 6 months) Hispanic Spanish- speaking English- speakingNon-Hispanic Routine exam/ check-up 48.3*53.257.7 Primary care visit (including check-up) 66.0*69.977.7 Inpatient stay5.1 6.9 4.7 Emergency room visit 25.328.9 26.6 *Statistically different from non-Hispanic children at <0.05 level. †Statistically different from English-speaking Hispanic children at <0.05 level.

8. 8 But children in Spanish-speaking families report less unmet need (% within past 6 months) Hispanic Spanish- speaking English- speakingNon-Hispanic Primary care visits0.6 *,† 3.9 5.2 Specialist care 1.3 0.0 3.1 Dental care9.1 *,† 21.918.9 Prescription medicines 0.6 0.4* 2.6 Mental health care 0.5 *,† 2.7 *Statistically different from non-Hispanic children at <0.05 level. †Statistically different from English-speaking Hispanic children at <0.05 level.

9. 9 Parents in Spanish-speaking families were satisfied with OHP Hispanic Spanish- speaking English- speakingNon-Hispanic Average rating of child’s health care (scale of 0-10) 8.48.6 8.1 Parent very or somewhat satisfied with benefit package (%) 90.7 *,† 81.687.5 Paid out-of-pocket for some of child’s health care costs (% yes) 9.9*13.318.9 *Statistically different from non-Hispanic children at <0.05 level. † Statistically different from English-speaking Hispanic children at <0.05 level.

10. 10 Multivariates Ran logistic regressions to predict utilization and unmet need. Controlled for gender, age, area of residence, parental education, parental employment, marital status, child’s health status. Results confirmed descriptives.

11. 11 A high percentage of children in Spanish-speaking families lacked prior experience with private insurance Hispanic Spanish- speaking (%) English- speaking (%) Non-Hispanic (%) Previously enrolled in the Oregon Health Plan 83.3*81.176.2 Previously covered by private insurance 29.7 *,† 66.466.7 Previously paid a premium for health insurance 30.2 *,† 55.267.4 *Statistically different from non-Hispanic children at <0.05 level. †Statistically different from English-speaking Hispanic children at <0.05 level.

12. 12 At application almost one- quarter of Spanish-speaking parents were eligible for ESI Hispanic Spanish- speaking (%) English- speaking (%) Non-Hispanic (%) Parent Eligible for ESI All23.427.522.4 Those employed full-time 23.6*31.034.2 Parent had ESI (of those eligible for ESI) 56.051.157.6 Child Eligible for ESI All 18.719.718.1 Those employed full-time 20.022.427.4 Child had ESI (of those eligible for ESI) 32.1 *,† 12.317.2 *Statistically different from non-Hispanic children at <0.05 level. † Statistically different from English-speaking Hispanic children at <0.05 level.

13. 13 Conclusions n Despite having poorer health status, Spanish- speaking Hispanic children in SCHIP use fewer services. l Differences in perceptions of need for care l May be cultural differences in rating health status n Covering Spanish-speaking Hispanic children through policies that promote ESI may be challenging. l Lack of experience with private insurance l Reliance on traditional safety net providers n Important to consider acculturation when analyzing the experience of Hispanic children.