How will Texas, with 38% of Hispanics uninsured, and California, with 29% of Hispanics uninsured, handle the coming influx of Hispanic healthcare consumers? Truth is -- no one really knows. The impact, however, will be enormous, and the system is not ready to handle it.
When the federal health care law is enacted in 2014, demand for services will dramatically increase. To meet the new demand, adequate supply must be available to avoid significant bottlenecks. That supply must include Spanish speaking doctors, nurses, administrators, and customer support networks. Without a long-range plan to care for Hispanics, people will be on the insurance rolls but will not be managing their health effectively, which will metastasize into costly situations.
Take a look at Massachusetts, which adopted the Universal Health Care Act in 2007:
"The largest increases in insurance coverage were among Hispanic respondents overall and Hispanic respondents who answered the survey in Spanish. Traditionally, a larger proportion of Hispanics in Massachusetts have lacked access to health care, compared with other racial/ethnic populations (9,10). The results showed an 18.4% increase for persons responding in Spanish and a 14.2% increase for Hispanics overall. However, despite these increases, Hispanics continued to have the lowest health insurance coverage and the lowest percentage of persons with a personal health-care provider than any other subpopulation......One reason might be that more time is needed for the effects of improved health-care access to be realized in these groups. Another reason might be that health-care providers are not equally accessible for certain groups or in certain areas of the state. Although the cost of a doctor visit might also be a factor, 2008 BRFSS data have shown that only 6% of all respondents reported that they were unable to visit a doctor during the past year because of cost, compared with 8% in 2006 (9). "
Short-Term Effects of Health-Care Coverage Legislation --- Massachusetts, 2008 March 12, 2010 / 59(09);262-267 - Center for Disease Control
In Massachusetts, Hispanics represent only 9% of the state's population, with the primarily Spanish speaking consumers portion even smaller, but the CDC data is highly significant. It shows a situation where an influx of new patients come onto the healthcare rolls but a certain percentage of them still do not get access to primary care, mostly due to accessibility, not cost. The CDC goes on to report that many of these patients are more disposed to certain disease states, particularly diabetes.
Left unaddressed this is a slow fuse cost time bomb. If addressed, it's an enormous opportunity for health care innovation. Prior to the Universal Health Care Act in Massachusetts, costs associated with a catastrophic diabetes incident (e.g. loss of a foot) would be covered by hospitals that passed the higher charges along to paying patients. Now these costs will are being passed back to the mandated health insurers who will be forced to evaluate new actuarial risk models and create new preventative programs to decrease risk. While coverage is nearly universal in the state, Massachusetts is suffering severe fiscal growing pains before the ticking time bomb goes off.
Now project this scenario to Texas and California where the Hispanic percent of population is much larger. Nationally, Hispanic Americans are the most likely to be uninsured, with 38.9% going without coverage in 2010, down slightly from 39.9% in 2009, according to Gallup. As national healthcare becomes law, we need significant shifts in how healthcare is administered. The expanding Hispanic population can help lead in three significant ways:
- Preventative care: Cost shifts will make preventive care and innovative programs that minimize catastrophic health incidents critically important. Blue Cross/Blue Shield of Massachusetts created a highly successful concierge service that manages patient health, including diabetes management. Through daily outbound calls by trained nurses, patients are counseled on their health management. This program has lowered costs and improved the health of patients suffering from diseases with high catastrophic outcomes. More programs will be needed, and some will have to focus on Hispanics specifically.
- Increased cultural understanding: Health administration must take a more culturally holistic approach. Health insurers traditionally segment their customers by life stage and disease state incidence in order to understand them. They will need to be more holistic. For Hispanics, this will mean health administrators, doctors, nurses, hospitals, and insurers will have to better understand Hispanic dietary practices, attitudes toward authority, and other value driven behaviors. Done effectively, these industry changes will create more effective health programs for Hispanics and might set the model for all customers.
- Pressure against certain corporations: The stakes are rising for companies whose products are perceived as contributing to bad health. Last year New York toyed with the idea of adding a surcharge on soda. This "Soda Tax" was justified by the state's high health care costs and soda's perceived ill affects. Coca Cola, Pepsi, McDonalds, and many other food and beverage companies are keenly aware of their vulnerability on this point and it's not hard to see how the California State Legislature might come after them for help with its mandated health insurance expenses. High sugar consumption is a large contributor to Hispanic diabetes. States may be forced to look at various "consumption" taxes to curb disease rates. This will have the effect of furthering corporate Health and Wellness programs, and may lead to an increase in corporate social responsibility initiatives toward health maintenance.
As with all industries, cost pressures will be a key factor for change in healthcare. The current infrastructure cannot accommodate the new influx of consumers whose culture removes them from the standard model. With innovation and close attention to the Hispanic market, the new American healthcare system will either rise to meet the needs of these cultural consumers, or go broke.