The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #58677

Elinor A Graham, MD, MPH¹, Troy A. Jacobs, MD, MPH¹, Jane Cover, MPH², and Tao S. Kwan-Gett, MD, MPH¹. (1) Department of Pediatrics, Harborview Medical Center, University of Washington, MS 359774, 325 9th Ave, Seattle, WA 98104, 206-341-4609, ellieg@u.washington.edu, (2) Sociology, University of Washington, 2002 Savery, Box 353340, Seattle, WA 98195

Language limitations and lack of health insurance impact access to care for poor, limited English proficiency (LEP) populations. In this study, a Medicaid managed care (MMC) database was used to determine health services utilization of LEP patients and compare them to English speaking patients of similar socioeconomic background and health insurance coverage in a setting with full access to medically trained interpreters. The sample of 1162 English-speaking patients and 567 LEP patients was drawn from patients aged 18-54 years, enrolled in MMC during a 2 year study period. Patients were identified as LEP if they had used a medically trained interpreter once. Mean months of Medicaid enrollment was longer for LEP patients (18.8 vs. 15.8 mos), fewer were enrolled 6 mos or less (15.2 vs.26.0%) and more were enrolled all 24 months (26.8 vs. 13.7%). LEP patients had more mean visits per member month (mvmm) enrolled to primary care sites (0.517 vs. 0.320mvmm), specialty care sites (0.246 vs. 0.188mvmm) but fewer to ER sites (0.134 vs. 0.177mvmm) and were less likely to have any hospitalizations. Utilization of care by disease groups showed LEP patients made more visits for atopic disease, chronic diseases and normal pregnancy. When language barriers are minimized and health insurance coverage is equal, LEP patients are enrolled longer and more consistently in Medicaid, than English speaking poor. They use more primary care and specialty care sites; less emergency room sites, fewer are hospitalized but they are more likely to be seen for chronic illness.

Learning Objectives:

At the conclusion of the session the participants will be able to: 1.Describe health care utilization patterns of poor, urban limited English proficient immigrants and refugees.
• List disease categories associated with higher utilization compared to English-speakers 3.Identify outcomes associated with care coordination in this population.

Keywords: Health Care Utilization, Immigrants

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: University of Washington
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: employed by University of Washington

Handout (.ppt format, 133.0 kb)