Association between language proficiency and the quality of primary care among a national sample of insured Latinos

Background: Latinos experience substantial barriers to primary care. Limited English language proficiency may be a mechanism for these deficiencies, even for Latinos with health coverage. Objective: To determine the relationship between English language proficiency and the experience of primary care reported by insured Latinos. Design, Setting, Participants: Analysis of the National Latino and Asian American Study, a nationally representative household survey, 2002-2003. This analysis was restricted to Latinos who reported current health insurance (n = 1792), and included information on ethnic subgroups. Main Outcome Measures: Four outcomes addressed different aspects of the quality of primary care: (1) not having a regular source of care or lacking continuity of care, (2) difficulty getting an appointment over the phone, (3) long waits in the waiting room, and (4) difficulty getting information or advice by phone. Results: English language proficiency was associated with the experience of primary care for 3 of the 4 outcomes. Insured Latinos with poor/fair English language proficiency were more likely than those with good/excellent proficiency to report not having a regular source of care or lacking continuity [odds ratio (OR) 2.20, 95% confidence interval (CI) 1.60-3.02], long waits (OR, 1.88; CI, 1.34-2.64), and difficulty getting information/advice by phone (OR, 1.76; 95% CI, 1.25-2.46). Conclusions: Among insured Latinos, low English language proficiency is associated with worse reports of the quality of primary care. These results suggest that interventions to address limited English proficiency may be important to improving the quality of primary care for this rapidly growing population.