State's Fastest-Growing Group Largely Uninsured, Lacks Information
About Medical Help
Irvine, Calif., April 19, 2002 -- Urban American Indians, California's fastest-growing ethnic group, overwhelmingly lack medical insurance and lack the access to health services that other ethnic groups often have, a UC Irvine College of Medicine study has found.
The study, one of the first to focus on the 70 percent of native Americans in California who don't live on reservations, pointed to procedural, cultural and educational barriers that need to be eliminated to increase access of health care to urban Indians. The study was part of a series of findings on minority health care access announced by The California Endowment.
Dr. Laura Williams, assistant professor of family medicine, Dr. F. Allan Hubbell, professor of medicine, and their colleagues found that nearly 45 percent of the urban Indians surveyed lacked health insurance, limiting the number of doctor visits and encouraging postponement of medical attention for children. In addition, the researchers found that health services available on reservations from the U.S. Indian Health Service were nearly nonexistent in urban areas, where most California American Indians live, often in poverty.
"Indians living in cities try to use Medi-Cal and Healthy Families for medical insurance," said Williams, herself a member of the Achjachemen tribe. "These services present barriers, however, including application and paperwork requirements regarded as confusing and onerous. Urban Indians also fear being looked down upon for participating in public health programs and confront health workers who are ignorant of American Indian culture."
The researchers interviewed 10 key Indian leaders in health care, conducted focus group discussions and surveyed nearly 200 American Indians throughout California. About 47 percent of uninsured Indians believed (falsely) that their children were not eligible for insurance if they were employed and 70 percent were afraid of being looked down upon for taking part in a public assistance program.
Barriers to enrollment included confusing and onerous paperwork requirements to apply for Medi-Cal and other programs, a lack of information about health services and some discrimination and ignorance of American Indian culture and health needs.
"The survey found several cases in which health workers misclassified Indians as Latino or Hispanic," Williams said. "In another case, a worker mistakenly thought that Navajos were not U.S. citizens. Clearly, the study shows a need for more effective outreach to urban Indians, and educational programs for health workers."
The researchers suggested that Medi-Cal and other public insurance programs simplify their application process and distribute information on out-of-state insurance access. They also suggested that outreach efforts be conducted in schools, at pow-wows, gatherings and sporting events. Training workers on American Indian culture would help reduce stereotypes and misclassifications, and extending Healthy Families coverage to parents would also improve the accessibility of health care in these communities, the study recommended.
Approximately 330,000 American Indians live in California, the nation's largest concentration. Only 30 percent live on reservations. Indians make up California's poorest ethnic group, with about 32 percent with incomes below the federal poverty level. A recent study indicated that about 20 percent of urban Indians lived in poverty.
The California Endowment and the Tomas Rivera Policy Institute supported the study. Williams' colleagues in the study included researchers from UCI's Center for Health Policy and Research and UCLA's Center for Health Policy Research, and advisors from the Southern California American Indian Working Health Group.
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