Home

Got health? The frustrating chase for insurance
By Ruthanne Salido

Litza Nitu is a woman on the run. But she's not running to escape; rather, she's running to find - seeking something that has been elusive: affordable healthcare insurance.

"I know I'm lucky - my kids are healthy, and I'm healthy," says Nitu, 42, who rents a home in La Cañada Flintridge, a suburb about 15 miles northeast of downtown Los Angeles . "But I also worry because my kids are athletic. And they are active and could get hurt. I am searching. I'm covered through next week. It's very depressing."

Nitu, who has lost two office jobs in the last two years because of companies' budget cuts, has struggled to find medical coverage for her and her two children, one of whom is in elementary school and the other in high school. She says that, as a mother, she worries more about her kids than herself "because, thank God, so far I am healthy."

Nitu, whose healthcare coverage is about to run out, is not alone in the struggle to find affordable healthcare coverage. More than one-third of Latinas (37%) are uninsured, over twice the rate of white women (16%), according to the Office on Women's Health in the U.S. Department of Health and Human Services (HHS). More than half of Latinas do not have dental coverage; almost 60% lack vision coverage, the office reports. Also troubling, according to HHS, is that while almost half of Hispanics do not have a regular doctor, Latinas in particular are much more likely to report problems finding specialized care. Problems of access for Latinas include affordability, lack of insurance, lack of transportation and language problems, HHS says.

The bottom line is that too many Latinas delay seeking routine medical checkups that could detect early danger signs, says Martha Froidevaux, a cardiologist who has her own practice and works out of White Memorial Medical Center in East Los Angeles, Providence St. Joseph Medical Center in Burbank, Calif., and the UCLA Medical Center. "I get patients late," she says, noting that the U.S. healthcare system is reactive rather than preventive.

Among the problems that affect many Latinas are heart disease, obesity, diabetes, breast cancer, cervical cancer, depression and HIV/AIDS, according to HHS.

Ranking these diseases in terms of their prevalence among Latinas "is very difficult and not very helpful" because there are so many variables, such as age, socioeconomic status and country of origin, says Jane Delgado, president and chief executive of the National Alliance for Hispanic Health, based in Washington , D.C. Perhaps the No. 1 health challenge facing Latinas is simply their tendency to neglect their own health needs, suggests Delgado, who says Latinas need to focus more on their own health. "They're not taking care of themselves because they're busy taking care of other people," she says.

"We're trying to treat the problems, not cure them," Froidevaux says. The HMO system, which requires that patients see a primary physician before seeking specialized help, is flawed because "primary care just patches them up," she says. "In this country, we don't want to give specialized care." So by the time patients get referred to Froidevaux, they're often in bad shape. "We're in the middle of a mess," she says. "We are trying to patch up the mess."

For low-income Latinas, healthcare access is even more difficult. "Hispanics are more likely than non-Hispanics to be employed in industries and jobs that do not provide health benefits. . In addition, the low incomes of many Latinos, as compared to other groups, make it hard to obtain individual health insurance outside of employer- or government-sponsored plans," according to HHS' Office on Women's Health.

That explains why lower-income people, regardless of ethnicity, tend to seek medical care when it's an emergency.

"The focus is not on preventive care," says Maria A. Hernandez-Valero, an epidemiologist at the University of Texas ' M.D. Anderson Cancer Center as well as the university's Center for Research on Minority Health. Often Latinas find access to Mexico 's healthcare system is a more affordable alternative. So with children in tow, it is not unusual for Latinas living in the U.S. near the Mexico border to cross into that country to get the health services they need, Valero says. "If you go to the border towns, you see many pharmacies, dental offices and medical offices all lined up. People go there for healthcare because it's cheaper."

And the healthcare is not simply less expensive, health advocates say, it can offer fewer barriers and a sense of understanding and comfort for patients.

The solution - Changing America 's healthcare system is one idea - but that could take a while, and the economics have become a political minefield.

The Office of Minority Health, in setting standards, is working to raise awareness and educate about cultural and linguistic competence in healthcare delivery. The National Alliance for Hispanic Health, founded in 1973 and describing itself as the nation's oldest and largest network of Hispanic health and human services providers, advocates improving healthcare for Latinos nationwide. Its website gives tips for contacting elected officials about upcoming health-related legislation.

In the meantime, there is something that Latinas can do right now.

"The change has to come from the home and from the family," says Froidevaux, the cardiologist. "The key is education. ..." We need to stress why we do things. You don't go to the gym because you have a free pass. You go because it makes you healthy."

She added that Latinas need to shake misconceptions about diet and exercise.

"It's unbelievable the ideas people have about things," she says. "My own mother is like that. She ate six tortillas, but the plate was big [so the tortillas looked smaller]. Besides, the concept was that tortillas don't have calories."

Ruthanne Salido is a freelance writer based in the Los Angeles . She works part time for the Los Angeles Times and teaches journalism and communications courses at a number of four- and two-year colleges in the L.A. area.  

Su Conexión

National Alliance for Hispanic Health: www.hispanichealth.org/

Office of Women's Health: www.womenshealth.gov/owh/pub/minority/index.htm