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This systematic review identified 77 studies to examine patterns and determinants of health care access among Hispanic immigrants (HI) living in the United States. In spite of major mental and physical care needs, HI and their families are at very high risk of not having access to health care compared with nonimmigrant Hispanics and non‐Hispanic whites. Noncitizenship status is a major barrier for accessing health care because of program ineligibility and fear of stigma and deportation. Low English proficiency is also an important barrier to health care. Culturally appropriate community outreach programs relying heavily on community health workers, also known as promotoras, have improved health care access and quality. Mexico shares the health care cost for HI living in bordering states, calling for a binational dialogue. Mixed‐methods research is needed to better understand (1) the net influence of acculturation on migrant health; (2) the role of informal (e.g., family) versus formal (e.g., promotoras) social support at facilitating health care access; (3) issues related to 'single' male migrant farm workers; (4) the "Hispanic mortality paradox"; (5) traditional healing and medicine among HI. Comprehensive health and immigration reforms are needed to respect the human right that HI have to gain access to health care.

The regional organization of the Spanish national health system offers a 'unique field' for exploring the sources of health inequalities as well as for testing the effects of political decentralization on health and healthcare inequalities. Drawing from the results of an empirical analysis where inequalities in three dimensions of health (outcome), healthcare (access) and healthcare payments (financing) are estimated, this article first explores the association between three such inequality dimensions alongside other system and socio-economic controls. Second, we examine whether the first wave of asymmetric healthcare devolution which took place in Spain between (1980—2001) — whereby health policy responsibilities were transferred to a few region states (autonomous communities [ACs]) — correlates with higher inequalities in health, healthcare and health financing. Our findings suggest that inequalities in health and healthcare appear to be driven by income inequalities and inequalities in use but not by inequalities in financing and health expenditure. Region states politically responsible for the organization of healthcare did not exhibit significant differences in health and healthcare inequalities and tend to exhibit a better equity performance.

AbstractThe Affordable Care Act's Medicaid expansion ushered in substantial increases in enrollment in the public insurance program. I analyzed rural–urban differences in access to health insurance, financial access to primary care providers, use of preventive care, and use of emergency department for medical reasons that did not lead to hospitalization. Low‐income rural residents were found to have greater reduction in likelihood of uninsurance than their urban counterparts. While an increase in the likelihood of routine check‐ups was found to be significant only among rural residents, a decrease in the likelihood of repeated visits to the emergency departments for nonurgent reasons was only significant among the urban population. I highlight the importance of understanding rural experiences to reduce rural–urban health disparities.

PurposeThe purpose of this paper is to assess disabled persons' access to health care, and highlight barriers.Design/methodology/approachA total of 245 rural men and women with physical disabilities were interviewed, to determine their level of access to healthcare services. A simple composite mean of the weighted average indices of responses on the effectiveness of healthcare provision, equity, and users' satisfaction was calculated, to assess the overall level of access of the respondents to healthcare. The qualitative component highlighted an array of barriers that prevented the disabled individuals from accessing healthcare services.FindingsThe results indicated that access to the so‐called "inclusive" public healthcare for both males and females with physical disabilities was poor. The barriers identified were related to the built environments, healthcare delivery processes, and ceiling of health subsidies. The findings suggest that the absence of advocacy of disability rights and failure to adopt circumstantial equities at dispensing levels have resulted in the collapse of the promotion of disability rights at grassroots levels.Research limitations/implicationsThe study is location specific (rural), and it mainly focuses on individuals with physical disabilities in working‐age (15‐35 years) to assess their access to the rural healthcare.Originality/valueHaving an effective healthcare provision in an area and its equal access to both males and females is crucially important for their social and economic development. In this paper, the assessment of access to healthcare provides both an aggregated and a disaggregated picture by gender, which is poor for individuals with physical disabilities.

Health disparities among racial and ethnic groups have a long history and continue to exist in the United States. The U.S. government has established as a goal for the year 2010 the elimination of racial/ethnic health differences in six areas. This article examines disparities in one of those areas: access to high-quality health care. Several measures of access to and use of health care services are studied both nationally and in 13 diverse states. The authors find that both the magnitude of racial and ethnic disparity and the reasons behind it depend significantly on the state, the ethnic group, and the type of outcome measure being studied. Such information can be valuable for state and national policy makers in targeting resources and in designing effective strategies for the elimination of racial and ethnic disparities.