Perceived Quality of Care, Receipt of Preventive Care, and Usual
Source of Health Care Among Undocumented and Other Latinos
Michael A. Rodríguez, MD1, Arturo Vargas Bustamante, PhD2, and Alfonso Ang, PhD1
1UCLA Department of Family Medicine, Los Angeles, CA, USA;2Department of Health Services, UCLA School of Public Health, Los Angeles, CA,
BACKGROUND: Latinos are the largest minority group in
the United States and experience persistent disparities in
access to and quality of health care.
OBJECTIVES: (1) To determine the relationship be-
tween nativity/immigration status and self-reported
quality of care and preventive care. (2) To assess the
impact of a usual source of health care on receipt of
preventive care among Latinos.
DESIGN: Using cross-sectional data from the 2007 Pew
Hispanic Center/Robert Wood Johnson Foundation
Hispanic Healthcare Survey, a nationally representative
telephone survey of 4,013 Latino adults, we compared
US-born Latinos with foreign-born Latino citizens,
foreign-born Latino permanent residents and undocu-
mented Latinos. We estimated odds ratios using sepa-
rate multivariate ordered logistic models for five
outcomes: blood pressure checked in the past 2 years,
cholesterol checked in the past 5 years, perceived
quality of medical care in the past year, perceived
receipt of no health/health-care information from a
doctor in the past year, and language concordance.
RESULTS: Undocumented Latinos had the lowest
percentages of insurance coverage (37% vs 77% US-
born, P<0.001), usual source of care (58% vs 79% US-
born, P<0.001), blood pressure checked (67% vs 87%
US-born, P<0.001), cholesterol checked (56% vs 83%
US-born, P<0.001), and reported excellent/good care in
the past year (76% vs 80% US-born, P<0.05). Undocu-
mented Latinos also reported the highest percentage
receiving no health/health-care information from their
doctor (40% vs 20% US-born, P<0.001) in the past year.
Adjusted results showed that undocumented status
was associated with lower likelihood of blood pressure
checked in the previous 2 years (OR=0.60; 95% CI, 0.43–
0.84), cholesterol checked in the past 5 years (OR=0.62;
95% CI, 0.39–0.99), and perceived receipt of excellent/
good care in the past year (OR=0.56; 95% CI, 0.39–0.77).
Havinga usual source ofcare increasedthelikelihoodof a
bloodpressurecheck in thepast 2 years and a cholesterol
check in the past 5 years.
CONCLUSION: In this national sample, undocumented
Latinos were less likely to report receiving blood pressure
and cholesterol level checks, less likely to report having
received excellent/good quality of care, and more likely to
receive no health/health-care information from doctors,
even after adjusting for potential confounders. Our study
shows that differences in nativity/immigration status
should be taken into consideration when we discuss
perceived quality of care among Latinos.
KEY WORDS: Latinos; quality of care; immigrants; preventive care.
J Gen Intern Med 24(Suppl 3):508–13
© Society of General Internal Medicine 2009
Latinos are one of the fastest growing populations in the US.
Approximately 45 million Latinos lived in the US in 20061, and
18% (8.5 million) are estimated to be undocumented immi-
grants.2Latinos report having less access to health care3and
lower use of health care compared to non-Latino whites.4–6
Latinos are also less likely to have health insurance coverage,7
which adversely affects health-care access and utilization.8
Legal status is an additional factor that affects undocumented
Latinos’ access and utilization of health care.9–10Most litera-
ture on quality of care has focused on the general Latino
population5with very few studies looking at variability among
Latinos by nativity and immigration status. This is the first
study that we are aware of using a national data set reporting
on perceived quality of care and receipt of selected preventive
care among Latinos by nativity/immigration status.
Several studies report that Latinos have fewer physician
visits, lower utilization of emergency services, and a lower
likelihood of having a regular source of care than non-Latino
groups despite research that suggests that Latinos have a
greater likelihood of chronic disease.11–12These differences
are particularly pronounced among undocumented Lati-
nos.9,13While 75% of the average population in the US
reported a physician visit in a recent national survey, only
56% of Mexican Americans and 59% of Central/South
Americans reported at least one physician visit in the same
survey.5,14Slightly more than one third of undocumented
Latinos (36.5%) reported having access to a regular health-
Published literature on quality of care suggests that the
patient’s perspective is an important element of quality of
care.5,15,16Positive perceptions of interpersonal processes of
care may influence patient outcomes through better adherence
to treatment regimens and greater motivation to manage their
health problems. As such, clinicians are encouraged to
acknowledge patients’ cultural beliefs and preferences, and
count of undocumented and more conservative estimates. A
related concern is that the survey missed those without phones,
underrepresenting the most vulnerable with worse quality of
services, thereby reducing the size of differences detected.
An additional limitation is the inclusion of barriers to
health-care quality linked only to inability to pay, racial/ethnic
background, and ability to speak English. In contrast with
other health-care surveys (MEPS, CHIPS) where barriers such
as cost or distance to the health-care provider are included,
our dataset had limited information available on such barriers
to quality of care. The limited range of alternatives might have
influence participant response by causing respondents to
endorse the few barriers at increased levels.
Previous research on the perceived quality of care among Latinos
has focused on either health-care quality differentials across
racial/ethnic categories or studied specific quality issues among
all Latinos, with limited distinction of nativity or immigration
status. While all foreign-born categories of Latinos were less likely
than US-born Latinos to have their blood pressure assessed or
receive any information on health or health-care from their
doctors, undocumented Latinos were the only group to also report
lower odds of cholesterol screening and worse perceived health-
care quality than US-born Latinos. Undocumented Latinos are
also the subgroup with the highest proportion reporting that their
supporting increased access to affordable culturally and linguis-
tically competent services could be beneficial to improve the
among Latinos by both nativity and immigration status under-
score the importance of future studies of Latinos appropriately
collecting29and reporting results by immigration status.
Acknowledgments: This project was supported by the Network for
Multicultural Research on Health and Healthcare, Department of
Family Medicine—UCLA David Geffen School of Medicine, funded by
the Robert Wood Johnson Foundation.
Corresponding Author: Michael A. Rodríguez, MD, UCLA Depart-
ment of Family Medicine, 10880 Wilshire Blvd #1800, Los Angeles,
CA 90024, USA (e-mail: firstname.lastname@example.org).
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Rodríguez et al.: Quality of Care Among Undocumented Latinos