Cross-border mobility, access to healthcare through health coverage, and other correlates for utilization of healthcare services along the U.S.-Mexico border

BACKGROUND: At the national level, Hispanics suffer from poor health coverage. This is amplified in Texas, which has the highest percent (26.3%) of uninsured individuals in the U.S., and further augmented in El Paso, TX. In some border states and counties, barriers to healthcare include medically underserved areas, low-income, and the recent immigration among the Hispanic population. Cross-border mobility has facilitated access to health services in Mexico. Despite this, there remain gaps in understanding utilization of healthcare services among Hispanics in El Paso, TX. AIMS & OBJECTIVES: The aims of this study are to: (1) describe access to healthcare through health coverage, utilization of healthcare services and other factors and to (2) assess the association between utilization and (a) access to healthcare through health coverage; (b) cross-border mobility; and (c) other socio-demographic characteristics among Hispanics living in El Paso, Texas. METHODS: This study is a secondary data analysis from a cross-sectional study conducted in the El Paso border region between 2011 and 2012 among 1152 self-identified Hispanics adults and marginally housed individuals in El Paso, TX. Measures included for this analysis were socio-demographic characteristics, access to healthcare through health coverage, utilization of healthcare services, and cross-border mobility. The outcomes in this study were health insurance, time since last medical check-up, country where medical treatment was sought, and medical care accessed in Mexico in the past three years. Descriptive statistics were provided and appropriate bivariate analyses were performed using Pearson Chi-Square for categorical variables and Mann Whitney-U test for continuous variables using SPSS Statistics v21.0. Significance was determined by p\u3c0.05. RESULTS: Participant\u27s median age was 30 years of age; 18.5% spoke only Spanish, 42.9% unemployed, 5.7% undocumented, and close to half of the participants were uninsured (55.4%), low income (59.4%), and had less than high school education (46.1%). Health insurance was statistically significantly associated with almost all measures. Time since last medical check-up was associated with most socio-demographic characteristics, health insurance, not having accessed health care services or pharmaceuticals due to cost and specifically in the United States. Country where medical treatment was sought was significantly associated to most socio-demographic measures except gender, income, and employment. Treatment sought in Mexico was associated with not having insurance, having needed health care services but unable to receive due to financial problems, having purchased pharmaceuticals in Mexico, and high frequency of visits to Ciudad Juárez. While treatment sought in the U.S. was associated with having insurance, having accessed inpatient services in the past 6 months, and trust/familiarity with U.S. physician/medications. Medical care accessed in Mexico in the past three years was only associated to gender, purchasing pharmaceuticals in Mexico, and having ever gone to Ciudad Juárez. CONCLUSIONS: Hispanic El Pasoans are marginalized for health coverage and utilization of health care services in the U.S. based on income, education level, citizenship status, migration generation, and language. Although the Patient Protection & Affordable Care Act seeks to improve health equity for U.S. citizens through health insurance coverage at a lower cost, this will have implications for those individuals that are non-U.S. citizens and for those that still find the health coverage inaccessible due to cost or lack of familiarity with the U.S. healthcare system. RECOMMENDATIONS: At this time Texas will not be creating a state-based health insurance marketplace but the findings from this study suggest that this would be beneficial for Hispanics in El Paso, Texas