Abstract
Studies suggest that proximity to a safety net clinic (SNC) promotes access to care among the uninsured. Distance-based barriers
to care may be greater for people with limited English proficiency (LEP), compared to those who are English proficient (EP),
but this has not been explored. We assessed the relationship between distance to the nearest SNC and access in non-rural uninsured
adults in California, and examined whether this relationship differs by language proficiency. Using the 2005 California Health
Interview Survey and a list we compiled of California’s SNCs, we calculated distance between uninsured interviewee residence
and the exact address of the nearest SNC. Using multivariate regression to adjust for other relevant characteristics, we examined
associations between this distance and interviewee’s probability of having a usual source of health care (USOC) and having
visited a physician in the prior 12 months. To examine differences by language proficiency, we included interactions between
distance and language proficiency. Uninsured LEP adults living within 2 miles of a SNC were 9.3% less likely than their EP
counterparts to have a USOC (P = 0.046). Further, distance to the nearest SNC was inversely associated with the probability of having a USOC among LEP,
but not among EP; consequently, the difference between LEP and EP in the probability of having a USOC widened with increasing
distance to the nearest SNC. There was no difference between LEP and EP adults living within 2 miles of a SNC in likelihood
of having a physician visit; however, as with USOC, distance to the nearest SNC was inversely associated with the probability
of having a physician visit among LEP but not EP. The effect sizes diminished, but remained significant, when we included
county fixed effects in the models. Having LEP is a barrier to health care access, which compounds when combined with increased
distance to the nearest SNC, among uninsured adults. Future studies should explore potential mechanisms so that appropriate
interventions can be implemented.
to care may be greater for people with limited English proficiency (LEP), compared to those who are English proficient (EP),
but this has not been explored. We assessed the relationship between distance to the nearest SNC and access in non-rural uninsured
adults in California, and examined whether this relationship differs by language proficiency. Using the 2005 California Health
Interview Survey and a list we compiled of California’s SNCs, we calculated distance between uninsured interviewee residence
and the exact address of the nearest SNC. Using multivariate regression to adjust for other relevant characteristics, we examined
associations between this distance and interviewee’s probability of having a usual source of health care (USOC) and having
visited a physician in the prior 12 months. To examine differences by language proficiency, we included interactions between
distance and language proficiency. Uninsured LEP adults living within 2 miles of a SNC were 9.3% less likely than their EP
counterparts to have a USOC (P = 0.046). Further, distance to the nearest SNC was inversely associated with the probability of having a USOC among LEP,
but not among EP; consequently, the difference between LEP and EP in the probability of having a USOC widened with increasing
distance to the nearest SNC. There was no difference between LEP and EP adults living within 2 miles of a SNC in likelihood
of having a physician visit; however, as with USOC, distance to the nearest SNC was inversely associated with the probability
of having a physician visit among LEP but not EP. The effect sizes diminished, but remained significant, when we included
county fixed effects in the models. Having LEP is a barrier to health care access, which compounds when combined with increased
distance to the nearest SNC, among uninsured adults. Future studies should explore potential mechanisms so that appropriate
interventions can be implemented.
- Content Type Journal Article
- DOI 10.1007/s10903-010-9425-6
- Authors
- Kristina M. Cordasco, The Greater Los Angeles VA Healthcare System, University of California, 11301 Wilshire Blvd (111G), Los Angeles, CA 90073, USA
- Ninez A. Ponce, The Center for Health Policy Research, School of Public Health, The University of California, 31-254B CHS, BOX 951772, Los Angeles, CA 90095-1772, USA
- Melissa S. Gatchell, The Center for Health Policy Research, School of Public Health, The University of California, 31-254B CHS, BOX 951772, Los Angeles, CA 90095-1772, USA
- Brandon Traudt, The Center for Health Policy Research, School of Public Health, The University of California, 31-254B CHS, BOX 951772, Los Angeles, CA 90095-1772, USA
- José J. Escarce, Department of Medicine, School of Medicine, The University of California, Los Angeles, CA USA
- Journal Journal of Immigrant and Minority Health
- Online ISSN 1557-1920
- Print ISSN 1557-1912