Is a Lack of Cultural Competency Closing the Doors on Access to Care for Those Most in Need?

As it pertains to my students undergoing clinical training, one of the social workers who is currently working in an elementary school in a predominantly Hispanic community recently discussed a situation of concern regarding a student’s mother. Because the social worker is bilingual, and from this particular community, she is a trusted resource for many local families of children who attend the school.

Knowing my medical social work background, I think she intentionally mentioned this case to discuss for assistance. She described to me a story of a student’s mother who came to the school asking for help from the counselors. She is a primarily Spanish-speaking woman who has been diagnosed with Stage 3 ovarian cancer. She has been paying cash for her medical appointments, because her husband is approximately $1,000 per month over income for Medicaid; however, he works for a small company as a painter and does not have health insurance.

When discussing the Marketplace coverage, the woman said she believed that she would not be approved for coverage because of her cancer diagnosis. When I asked about the oncology office, the social worker stated that they worked out a cash price for the patient as a 50-percent discount; however, with the expectation of chemotherapy she cannot afford the treatment. 

I could go on about what occurred in this case and the missteps of this office in failing to support her by not assisting her in obtaining health insurance, much less the lack of willingness to help her apply for Social Security disability. I also could go on about the lack of cultural and empathic support from this office, as this woman must now face a difficult prognosis while trying to parent small children. 

I tell this story because ironically, this past week, Kaiser Family Foundation (KFF) news posted their report on Health and Health Care Experiences of Immigrants: The 2023 KFF/LA Times Survey of Immigrants | KFF. The narrative highlights a disappointing story in our healthcare system, wherein we fail to acknowledge and recognize cultural biases and their impact on health equity.

The survey of 3,300 participants found that 29 percent of respondents stated that it is hard to receive respectful and culturally competent care. The study also highlighted that because of the trend in employment with and/or running small businesses among immigrant families, the majority of the population is often over-income for Medicaid, but lacks access to health insurance, likely because of cost. Additionally, the study found a hesitancy of immigrants to seek healthcare services, regardless of citizenship, citing prevalence of immigration-related fears and language barriers being the primary reasons.

The study reviewed the relevant differences that exist among coverage for immigrants in states that have expanded Affordable Care Act (ACA) Medicaid coverage and those who do not. The report even goes into the disparities among this population in seeking assistance for housing, food, healthcare, or other social programs because of the concern and confusion around inconsistent eligibility requirements. 

In the recent publication on the CMS Framework for Health Equity 2022–2032, the Centers for Medicare & Medicaid Services (CMS) provides their top priorities to improve health equity in our country, with priority 3 and 4 most aligning for a recommended increase in culturally tailored services and greater workforce support to reduce disparities. Maybe the report was intended to be vague or high-level, but it missed the direct need to address implicit biases on healthcare delivery or mention a path for greater minority representation among healthcare providers.

As much as healthcare is striving to be the answer to all social complexities, it is relevant to note that my patient story was impacted by the local school counselor who was compassionate enough to try to find answers and connect this woman with the resources she needs.