Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May;35(5):1490-1497.
doi: 10.1007/s11606-019-05609-z. Epub 2020 Jan 2.

Disparities in Health Insurance Coverage and Access to Care by English Language Proficiency in the USA, 2006-2016

Tianyi Lu  1 , Rebecca Myerson  2
Affiliations

Disparities in Health Insurance Coverage and Access to Care by English Language Proficiency in the USA, 2006-2016

Tianyi Lu et al. J Gen Intern Med. 2020 May.

Abstract

Background: In the USA, people with limited English proficiency (LEP) disproportionately experience gaps in health insurance coverage and access to care. The Patient Protection and Affordable Care Act (ACA) of 2010 included reforms that could improve these outcomes.

Objective: To describe changes in insurance coverage and access to health care by English language proficiency over 2006-2016.

Design: We used regression models to estimate changes in coverage and access after 2010 for adults with high vs. limited English proficiency, adjusting for socio-economic status, demographic characteristics, and health care needs. We used difference-in-differences models to assess adjusted changes in disparities by English proficiency after 2010. Supplemental analyses used nearest-neighbor propensity score matching to balance the characteristics of respondents.

Participants: Respondents aged 18-64 in the Medical Expenditure Panel Survey over 2006-2016, with high (n = 174,214) or limited (n = 16,484) English language proficiency.

Main measures: Insurance coverage was a binary variable indicating any health insurance coverage during the past 12 months. Access to care was measured using binary variables indicating whether the respondent had a usual source of care and received necessary medical, dental, and preventive care.

Key results: Gains in health insurance coverage after 2010 were significant for adults with high English proficiency (1.7 percentage points, p < 0.001) and adults with limited English proficiency (4.6 percentage points, p = 0.007); gains did not significantly vary by English proficiency. Adults with LEP showed larger improvements than adults with high English proficiency in having a usual source of care (5 percentage points, p = 0.007) and receiving needed medical care and dental care (1.4 percentage points, p = 0.013, and 2.8 percentage points, p = 0.009, respectively). Findings remained similar when matching was used to balance the measured characteristics of respondents with high vs. limited English proficiency.

Conclusions: Disparities in health care access by English proficiency narrowed after 2010, the year of passage of the ACA.

Keywords: English proficiency; access to care; disparities; health insurance; health policy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Ryan C. Language use in the United States: 2011. American Community Survey Report 2013;22:1–16.
    1. Zong J, Batalova J. The Limited English Proficient Population in the United States. Washington, DC: Migration Policy Institute; 2015.
    1. Caesar LG. English Proficiency and Access to Health Insurance in Hispanics Who Are Elderly: Implications for Adequate Health Care. Hisp J Behav Sci. 2006;28(1):143–152. doi: 10.1177/0739986305284018. - DOI
    1. Gonzales G. State Estimates of Limited English Proficiency (LEP) by Health Insurance Status. The State Health Access Data Assistance Center (SHADAC); 2014.
    1. Ponce NA, Hays RD, Cunningham WE. Linguistic Disparities in Health Care Access and Health Status Among Older Adults. J Gen Intern Med. 2006;21(7):786–791. doi: 10.1111/j.1525-1497.2006.00491.x. - DOI - PMC - PubMed

LinkOut - more resources