There are two main hurdles to getting quality health care among the Latino population, according to David Hayes-Bautista, founding director of UCLA medical school's Center for the Study of Latino Health and Culture.
Access is the No. 1 issue and linguistic competency is No. 2, Hayes-Bautista said.
Hayes-Bautista was part of a forum convened last week in Sacramento by the Latino Community Development Foundation -- a forum that included Health and Human Services Secretary Diana Dooley and a number of state Senate and Assembly members.
Nationwide, there is a ratio of 308 physicians per 100,000 patients in the white community, according to Hayes-Bautist. For Latinos, the ratio of physicians to patients dips down to 108 per 100,000. It's a big gap, one that widens in California.
"The biggest disparity is right here in California," Hayes-Bautista said. "You're looking at 376 physicians for whites, and only 56 for Latinos. This is a huge disparity. California lags way behind other states," he said. "Even Texas."
Once Latino patients do find a doctor, he said, odds are that physician won't speak Spanish.
"About 70% of Latino physicians speak Spanish," he said, "but only 4% of white physicians speak Spanish."
When you consider the biggest health issues in the Latino community are lifestyle-related -- diabetes, obesity, heart conditions, blood pressure -- those two issues of access to preventive care and linguistic competency take on even greater meaning, Hayes-Bautista said.
"Look, it's hard to get patients to change their behavior," he said. "What you need to do is work with a patient so that they want to do it." That's nearly impossible, he said, given existing access and language barriers.
"What would be the quality of care, for example, for a diabetes patient," Hayes-Bautista asked, "where no doctors practice in the area, and the few you can find don't speak Spanish?"
Health care reform will help, Secretary Dooley said, by making sure more people get affordable health care insurance coverage.
"Coverage doesn’t always equal access," Dooley said.
The key to fixing cultural disparities in health care means a more systemic approach, she said.
"A lot of people are working in this state and trying to decide how to redesign the model of care," she said.
The state health benefits exchange is part of that process, but Dooley said work needs to be done in other areas to address Latino concerns, rather than just hoping for the exchange to fix everything.
"I mean, right now, there is no call center yet. There's no consumer website. What we can do now is we can do a lot of work from a coverage standpoint."
Beyond that, she said, California can't get those other aspects of the exchange moving until the exchange is ready to go in 2014.
"We can't get everyone dressed up for the prom," Dooley said, "and not start the music."