Going to see a health care provider is often a frustrating
and demeaning experience for people of color, as well as those who are LGBTQ or
have disabilities, according to a preliminary report by the California
Pan-Ethnic Health Network.
The health advocacy group collected testimony from dozens
of health care consumers, including Asian and Latino immigrants in Southern
California, Native American residents in Sacramento, LGBTQ individuals in
Ventura County, black women in Los Angeles, and people with disabilities in the
Bay Area.
While their backgrounds and circumstances varied widely, the
stories they told about their health care experiences were similar, said Kiran Savage-Sangwan, executive
director of the Pan-Ethnic Health Network. Across race, culture, circumstances
and region, people struggled to understand the health care system, obtain
timely appointments, find caregivers and facilities sensitive to their needs,
and afford medical costs, the report found.
“There are differences between the populations, but
there are a lot of common themes,” said Savage-Sangwan.
“We continue to hear a lot about barriers to accessing care even when you
have insurance. Most of the people we talked to are insured—many through Medi-Cal,
others through employer-sponsored health care—but they continue to face
difficulties.”
Six partner organizations representing different minority
groups collaborated with the nonprofit to hold focus groups across the state
during July and August. The goal was to find
out what diverse communities think about their health care, in
order to figure out ways to make the system better.
Heng Lam Foong organized a focus
group on behalf of Asian Americans Advancing Justice in Los Angeles that
included people of Vietnamese, Filipino, Chinese, Thai, Korean, Nicaraguan and
Guatemalan descent. Some were first-generation immigrants, others were born in
the United States. Some were undocumented, some had green cards or were
citizens.
“Generally what we heard from everyone … is
that the health system is confusing,” she said. “And there are
different levels of access for individuals depending on whether you have health
insurance, or if you’re on government-sponsored insurance.” Those who reported
the most difficulty accessing health care had coverage through county-managed
plans, such as My Health LA or Healthy San Francisco, she said.
Several people in the focus group complained of long wait
times to get an appointment. Then when they arrived at the doctor’s office, they often also spent a long time in the waiting room. One
man spoke about how his Vietnamese mother waits two to four hours to see a
provider at a clinic where the doctor speaks her language. An uninsured
immigrant woman said she had to line up at 3 a.m. to get her tooth extracted at
a practice clinic for dental students.
Language barriers were another common problem reported by
focus group participants, Lam Foong
said. People described not receiving adequate translation services and being asked
to sign stacks of medical documents they didn’t understand. One man said
he regularly had to miss work to interpret for his grandmother at the doctor’s
office because the translator on staff didn’t speak her language fluently, Lam Foong recounted.
People with disabilities who participated in
a focus group also reported inadequate and insensitive care, said Silvia Yee, senior
staff attorney with Disability Rights Education and Defense Fund in Berkeley. Yee
said people with disabilities are often disregarded when it comes to studies on
understanding health care disparities, yet they are routinely discriminated
against.
Challenges for people with disabilities include
obtaining routine medical care that’s accessible to them. Despite improvements
in recent years, one study
found that less than 20 percent of doctor’s offices in California had scales
and examination tables accessible to people in wheelchairs.
Race and sexuality can
compound the problems that people with disabilities face in the health care
system, Yee added. An African American man in the focus group who suffers from
hearing and vision loss recounted how staff at a medical clinic mistook his
disabilities as a sign of substance abuse. He went to the clinic seeking help
for a food allergy, but workers kept asking him if he used illegal drugs.
In another instance, a non-gender conforming person in a
wheelchair described struggling to get advice on STD testing because the doctor
didn’t believe a disabled person could have a sex life, Yee recounted.
To improve health care for people from diverse backgrounds, the state
needs to do a better job of collecting and measuring demographic data on
race, ethnicity, sexual orientation, gender identity, disability and language, Savage-Sangwan said. Additionally,
consumer health care protections that are already on the books, such as the
right to an interpreter, need to be better enforced, she said.
“I think the broader question is, what does the health care
system really need to look like to be equitable, so that consumers have an opportunity
to have good health?” she said. “I think that’s where we all need to
do a lot of thinking together, and particularly bring the voices of consumers
to the forefront of that conversation.”
