Understanding health care service utilization among Hispanics in the United States: A modified behavioral model approach

The objective of this dissertation is to use the behavioral model of health care utilization developed by Andersen and colleagues to identify the correlates and predictors of health care utilization for Hispanics in the United States. The specific goals of the present research are to: (1) focus attention on the understudied population of Hispanics in the United States, paying particular attention to elderly Mexican Americans and differences among Hispanic ethnicities; (2) better inform the behavioral model of health care utilization by including indicators of acculturation, context of reception and county level information on economics, age structure, and health care access; and (3) better test the model by using structural equation models to examine the direct, indirect and interactive effects of the model components. Using data from the Hispanic Established Population for the Epidemiological Study of the Elderly, the Area Resource File, the Medicare Directory of Participating Physicians and the National Health Interview Survey, results indicate that predicting health care services utilization is complex and not just about need. It is further shown that when only the direct relationships between predisposing, acculturation and enabling factors with utilization are examined, we fail to recognize the impact of important social factors. Finally, it is argued that the assumption of invariance across both need and ethnicity is invalid, and that the process of health care services utilization operates differently among those in good versus poor health and among the different Hispanic ethnicities.