Access, Utilization and Quality of Health Care of Latino Children with Autism and Developmental Disabilities

Background: Research has found disparities in whether children receive a diagnosis of autism between Latinos and non-Latino whites (Mandel et al., 2009; Palmer, et al., 2010). However research on whether there are disparities in health care for Latino children with autism compared to non-Latinos is sparse. Using a national sample of children, Liptak and colleagues (2008) found that Latino parents in the sample rated their children as being more severe, and that being Latino was associated with decreased access to health services. The present study investigates disparities in health care access, utilization and quality of care between Latinos and non-Latino whites in a sample of children with autism and other developmental disabilities. We hypothesize that Latino children will have worse access to health care, lower utilization, and that their parents will report worse quality of care than non-Latino whites.

Methods: This study used the National Survey of Children with Special Health Care Needs which is a randomized telephone survey conducted by the National Center for Health Statistics from April 2005 to February 2006. We included 5,110 children who had developmental disabilities in our analyses, including 2,132 with autism. Twelve percent of the sample consisted of Latino children. We conducted logistic regression on variables relating to health care access, utilization and quality adjusting for income, education level, parent marital status, severity of condition, age of child and health insurance status.

Results: Our findings extend and corroborate those of Liptak et al (2008). We found disparities in health care access among Latino children compared to non-Latino whites. Latinos were less likely to have public or private insurance, and were less likely to have a usual source of care. In the health care utilization category, they were more likely to have difficulty using services, more likely to indicate problems with referrals, and more likely to say they did not receive routine care. With respect to health care quality, Latino parents were more likely to report they were not satisfied with their child's health care services and that the provider was not sensitive to family values and customs. These findings did not vary by whether the child had autism versus other developmental disabilities.

Conclusion: Our findings on health care access replicate previous research and contribute information needed to understand why Latino children are less likely than whites to be diagnosed with autism. Our findings regarding health care utilization and quality are the first analyses of their kind, and establish new evidence of ethnic disparities among children with autism and other developmental disabilities. The finding that Latino families were more likely to say their health care providers were not sensitive to family values and customs is troubling. This finding suggests that health care providers must improve their understanding of cultural issues if they are to effectively meet the health care needs of Latino children with disabilities.