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Healthcare Access and Utilization Among Women 40 Ano Older at the U.S .-Mexico Border: Predictors of a Routine Check-Up

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Healthcare Access and Utilization Among Women 40 Ano Older at the U.S .-Mexico Border: Predictors of a Routine Check-Up jrmmaJ o/ CommunilJ Hudlh. Vol. 28, No. J, Oaober 2003 (O 2003j HEALTHCARE ACCESS AND UTILIZATION AMONG WOMEN 40 ANO OLDER AT THE U.S .-MEXICO BORDER: PREDICTORS OF A ROUTINE CHECK-UP Jennifer B. Humer, MPH, MA;Jill Guernsey de Zapien, BA; Catalina A. Denman, PhD; Eva Moneada, MD, MPH; Mary Papenfuss, MS; Danelle Wallaee, MPH; Arma R. Giuliano, PhD AB5TR.l.CT: Mexican Americans are more likeiy lO experience barriers lO access and ulilization of heahhcare services than any olher U.S. His· panic group. In Mexico, where the majority o f me popuiation has access lO care, the pressing issue is the underutilization of preventive services among adults. This Sludy was conducted to assess access and utilization barriers among a U.s.-Mexico border population. A cross-seClional, pop­ ulation·based suryey was conducted during 1999-2000 in a pair o f con· tiguous U.S.·Mexico border communilies. Household su¡;¡eys were ad· minislered tO U.S. and Mexican women. 4.0 years of age and oider. tO assess hea1thcare access and utilization. panicipation in chronic disease screenings, orientalio n toward prevention and personal hinor)' of chron ic disease. Analysis indicates few statistically significanl differences (p < 0.05) among access and utilization variables by eountry. Mexi can panicipants were more likely to have a regular source of care and to have had a blood sugar lest within the past 12 months. U.5. panicipants more often reponed having had a Pap smear and mammogrnm during lhe previous year. Factors independenuy positively associaled with havo ing had a routine check·up during the past 12 mom hs included age and having a regular provider or place to go when sick. Only going lO the doctor when ill was independently inversely associated with routine jennifer B. Hunter i5 DireClOr o{ Data Collection and Recruitment for Community·Based Res(':l1"ch Projecl5 al ¡he Southwest Center for Communily Heallh Promolion, Me! and Enid Zucker· mOln Arizona College of I'ublic Health. Universily of Arirona: jm Guemse~· de Zapien is ,l.s5ociale Dean for Communitv Progranu at Ihe Me! and Enid Zuckennan Arizona CoHege of Public Health. Uni"ersity of ..vizona: Cat.alína A. Oenman is Profcssor and Researcher. Progr.un on He:alth and Soc;i. ety al El Colegio de Sonor,¡., Hennosillo. Sonora. M6.-im; F.va Moneada ;5 DireclOr. Deparullem of Priority Prognms in Child and Adolescent Heahh at the Secretaria de Salud. Hermosillo. Sonor.!. México; Mal)' Papenfuu is Researc;h Specialist. Principal. Cancer PrC'o'ention and Control al the ..>,ri. tona Canccr Ct:mer. Ulli"elsilY uf ,>\1 ilOna. DaneUe Wallace is RCKlIrch Spcciali$t, Cancer PrC'o·ention and Control, al me ..>,rizona Cancer Center. Univen ity of Arizona: Anna R. Giuliano is ,.u5OCÍate Professor of Epidemiology at the Md and Enid Zuckerman Arirona College of PubHc Health and Co> Director of Cancer Prevemion and Control, al the Arizona Cancer Center. bolh al the Universilll of Arizona ' Requcsl5 {or reprinu should be addrcssed 10 jennircr B. Hunter. MPH. ~M., SoUthwC5t Ccmee ror Communíty Health Promotíon. Me! and Enid Zuckennan Arirona CoHege of Public; Health. University of Arizona, PO Box 210228. 1145 N, Campbell Ave .. Tucson. AZ 85721: e.mai l:jhuntcr®u. arizonaedu. 317 318 JOURNAL OF COMMUNfIY HEALTH check.ups in the past 12 months. Findings suggest mal U.$. and Me:cican border populations are similar with regard to healthcare access and Uúli­ zation characteristics. [ffons to increase uúlization of preventive health screenings among women are needed at the U.S.-Me:cico border. REY wQRDS: U.S.-Mexico border: heah.hcare access and utilization: routine ched:-up. INTRODUCTION Barriers that decrease access lO and uti1izatiO'n O'f healthcare ser­ vices cO'ntinue to be a significant prO'blem in the U-S. where a large seg­ ment úf the pO'pulatiO'n is uninsured. In 2001, apprO'ximarely 41 milliO'n peO'ple, O'r 15% úf the pO'pulatiO'n, were uninsured.' While this represents an unfavO'rable statistic fO'r the U.S. as a whO'le, sorne pO'pulation grO'ups, such as Hispanics, have dispropO' rtiO' nately púO'rer access to healthcare due tO' lack O'f insura!lce cO'verage. Mexican Americans, whO' make up the majority (62.3%) O'f the U.5. Hispanic populatiún are the least likely Híspanic subgroup lO be insured, ro have recently visited a physician or to have preventive examinatiO' n s.2.3 · ~ These factors can have significant repercussiO'ns O'n the health status of a púpulatiún. Barriers rO' accessing healthcare, such as lack of health insur­ ance, negatively impact tbe utilizarion of services. The uninsured are less likely tO' repon recent physician vis its or a usual source of care, and they receive fewer screening exams fúr cancer and chronic disease risk fac­ tors. ~·6.7 Because Hispanics, and mO're specifically Mexican Americans, are disproportionately affected by barriers that decrease access and utilization of healthcare, a study was conducted ro assess these factors among a U.5.­ Mexico binational border population. The U.5.-Mexico border spans four U.5. and six Mexican states. Today, the regio n is estimated to have a tNal populatiún of 11.5 million.8 While patterns of cross-bO'rder healthcare utili­ zation have been documented historically, ir is alsO' important tO' consider access and utilization characteristics of this binational population sepa­ rately but within rhe context O'f the border regiún to better understand how health promO'tion efforts can effectively target the population. Whereas Mexican A.mericans in the U.5. face significant barriers to access and utilizatiún of healthcare, in Mexico, where the majúrity of the population has healthcare coverage, the more pressing issue is the under­ utilization of available preventive healthcare services among adults. The Mexican 5ecrecary of Health's Action Plan for Diabetes Mellitus repons that 25-40% of diabetics are managing their condition but only a small - Jennifer B. Huoter el al. 319 fraerian of mose wha have their conditioo under control actually go for regular health services.9 In Sonora, the Mexican state that borders Arizona. mast residents have access to health seIVices at one of severa! institutions. The Instituto Mexicano de Seguro Social (Social Security) or IMSS, offers services to aH privare sector workers and their families. Omer social security systems. 5uch as the Instituto de Seguridad Social para los Trabajadores del Estado or ISSSTE (and ISSSTESON in the state of Sonora), cover federal, county and state government workers and their families. The Secretaría de Salud (Secrerary of Health) covers the remainder of the population or what is referred to as the "open population." Although the "open popularían" the­ oretically has access to health care, they are ofren charged "cuotas de re­ cuperación n (similar tO sliding fee scales) which have become more similar te privare medicine costs. IO Overall, approximately 55% of Mexico's popu­ lation receive healthcare services from a social security institution. An­ other 35% are covered by agencies that provide services to the uninsured or the ~o pen population." The final 10% of (he population either uses privare services or have "no easy access to permanent facilities. nll Since the mid-1980s, s{udies have focused on pauerns of health 12 15 service utilization amo ng members of contiguous border communities. - However, none have focused specifically o n older women and their screen­ ing utilization for chronic disease. The purpose of this paper is to compare healthcare access and utili­ zation indicators, insuran ce status and participation in chronic disease screening exams among women 40 years of age and older by country of residence at [he U.S.-Mexico border. Facters associated with having had a routine check-up in the Jase 12 months are also discussed. METHODS Study Population A cross-sectional, population-based survey was conducted from Au­ gust L999 to September 2000 in the contiguous border communities of Agua Prieta. Sonora, Mexico and Douglas. Arizona. U.S. In Douglas, 100% of all households were randomly selected from maps of the community. In Agua Prieta. specific low- and moderate-income level census tracts were chosen. Within each census tract, households were randomly selected with every 3M house visited. Three altempts were made by interviewers t O contact a potentially 320 JOURNAL OF COMMUNITY HEALTU eligible woman from each selected household before excluding the house from the survey. Attempts were made on different days at different times. If more than one woman per household was eligible tú participate, the woman whose birthday was nearest the date of the interviewer's visit was invited to participate. Sixty-nine percent of those contacted in the U.S. community re­ fused to participare in the.study. Common reasons for refusa! among U.S. women were that they did nor have the time or they were not interested in participating. The high refusal I"ate is attributed in part tú the environ­ ment along this portion of the border in 2000. During the household re­ cruitment phase of the study, southeastern Atizona became a "hot spot" for undocumented migration. Television and newspaper coverage docu­ mented the extensive number of workers who flocked tO this area of the 16 17 border in search of work in the United States. This ¡nflux of undocu­ mented workers along with Border Patrol reinforcements of both man­ power and equipment resulted in aclimate of tension and fear among resl·d ents o f th·e D ouglA' as, nzona commumty. 1819. There were no refusals among women in the Mexican community due ro the fact that nurses from the local c1inic in Agua Prieta recruited women for the study and conducted the household surveys.
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