摘要：Objectives. We investigated whether access to and use of health care services increased among residents of a low-income, predominantly Mexican American border community affected by the expansion of Arizona’s Medicaid program in 2001 and multiple community-level programs and policies. Methods. We used data from a probability sample of 1623 adult residents of Douglas, Arizona, who participated in cross-sectional health surveys in 1998 and 2010. Response rates were 83% and 86%, respectively. Results. In 2010, participants were more likely to have a usual source of care, to have visited a provider in the previous year, and to have been screened for diabetes and hypertension and less likely to have delayed needed care or to have seen a regular provider in Mexico ( P < .001 for all outcomes). Improvements in access to and use of health care were most pronounced among residents with less than a high school education, which reduced or eliminated educational disparities in health care. Conclusions. Expansion of public insurance programs can effectively reduce health care disparities when paired with other community-level policies and programs that target medically underserved populations. Mexican Americans and other Latinos suffer from a high burden of chronic disease. 1,2 For example, 79% of Mexican American adults and 78% of all Latino adults are overweight or obese compared with 67% of non-Hispanic Whites, and half of Latinos born in 2000 will develop diabetes in their lifetimes compared with less than one third of non-Hispanic Whites. 1,2 Identifying effective programs and policies to improve the health of Mexican Americans and other Latinos is a top public health priority, both to reduce health disparities and because even small improvements can yield large health and economic benefits at the population level. Poor access, use, and quality of health care services may contribute to high rates of chronic disease among Mexican Americans and other Latinos. Latinos are less likely than are other racial/ethnic groups to have health insurance, attend regular medical checkups, have a usual source of care, or be regularly screened for several forms of cancer and other chronic conditions. 3–8 Latinos are also more likely to delay needed care, have chronic conditions that go undiagnosed or are diagnosed at later stages, have negative outcomes related to their chronic conditions, and be unsatisfied with their providers. 4,9,10 Health care access and use is even poorer among Mexican Americans than most other Latino subgroups. 4 Latinos face numerous social, economic, and structural barriers to health care. As a group, Latinos have low income, high poverty rates, and poor educational attainment, factors consistently found to affect health and health care. 11–13 One third of Latinos are immigrants and 41% of Latino immigrants speak English less than very well, factors that can lead to linguistic and cultural barriers to health care. 13,14 Many immigrants, including 6 million who are undocumented, are ineligible for public health insurance programs that subsidize health care for other low-income populations. 15–17 One potential way to reduce health care disparities faced by low-income and minority populations, including Latinos, is through public policy. The Affordable Care Act (ACA) includes several provisions expected to curb uninsurance and increase access to and use of health care services among medically underserved populations, including an individual mandate requiring most Americans to have health insurance; public health insurance exchanges that can be used to buy affordable, high-quality, and often subsidized insurance; and expanded eligibility for Medicaid to include individuals with incomes up to 138% of the federal poverty level (FPL) as set by the US Department of Health and Human Services. 18 It is important to understand whether the ACA and other policy- and community-level interventions can effectively reduce health care disparities that Latinos and other low-income and minority populations face.
