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California Latinos’ Use of Emergency Medical Services Rose During Pandemic

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Prior to the COVID-19 pandemic, Latinos in California were relatively unlikely to use emergency medical services. But during the pandemic, across much of the state, Latinos’ use of such services — specifically seeking treatment for respiratory ailments — increased more than it did for non-Latino whites, according to a new report by the UCLA Latino Policy and Politics Initiative. The report’s authors compared figures for the first six months of 2020 to statistics for the same period in 2019. They analyzed data from the California Emergency Medical Services Information System, which includes information from all of the state’s 33 local emergency medical service agencies with the exception of Los Angeles County. “Although the study doesn’t directly account for about 30% of California’s Latinos who live in Los Angeles, other studies on the impact of COVID-19 on Latinos in L.A. would suggest that the same phenomenon would hold true in Los Angeles,” said Esmeralda Melgoza, a doctoral student at the UCLA Fielding School of Public Health and a co-author of the report. The study’s findings suggest that emergency medical services statewide have an opportunity to improve their language and cultural literacy to better serve the needs of their Latino patients. The study identified factors that kept Latinos from using emergency services prior to the pandemic, including concerns about the costs of emergency care and fears that interaction with public safety officials could endanger their immigration status. After the pandemic began, their use of emergency services for urgent respiratory illness pointed to the toll COVID-19 took on Latino essential workers and families. — Rodrigo Dominguez-Villegas

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U.S. Sick and Medical Leave Policies Widen Racial Inequalities, Study Finds

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Paid sick and medical leave is a powerful tool for preventing the spread of COVID-19 and other diseases and ensuring all workers have access to treatment, yet tens of millions of American workers lack coverage. The U.S. is one of just 11 countries in the world without a national, permanent paid medical leave policy, according to new research led by Jody Heymann, distinguished professor of public health, public policy and medicine. Further, unpaid leave provided by the U.S. Family and Medical Leave Act (FMLA) is restricted by eligibility rules that have created marked racial and gender gaps, said Heymann, who directs the WORLD Policy Analysis Center at the UCLA Fielding School of Public Health. The study, published in Health Affairs, included these findings:

  • In the private sector, 18.7% of Latinas, compared to just 8.4% of white men, lack access to FMLA leave because of its minimum annual hours requirement.
  • Requiring one year with the same employer excludes higher shares of Black (22%), Indigenous (22.9%) and self-identified multiracial (27.7%) workers than white workers (19%).
  • Over a third of private-sector workers are employed by a business with fewer than 50 employees, making them ineligible for FMLA benefits.

The study’s analysis of data from 181 countries found that providing paid sick and medical leave to all workers — including the self-employed, a group commonly excluded from key social security and labor protections — is readily achievable. “Only by ensuring we design our paid leave policies to reach every worker can we protect public health and take one important step toward rectifying the longstanding and devastating racial and socioeconomic inequalities that have only intensified during this pandemic,” Heymann said.

 

Shah Co-Authors Report on Disproportionate COVID-19 Risk Among Latinos Local context is a key factor in the level of risk, the study of Medicaid patients in Contra Costa County finds

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By Stan Paul

UCLA Luskin Professor of Public Policy Manisha Shah co-authored a study, published in the American Journal of Preventive Medicine, that showed Latinos had much higher odds of testing positive for COVID-19 than whites.

The USC-UCLA study, conducted in a Northern California regional medical center with a diverse group of adults enrolled in a county Medicaid managed care plan, also indicated a marked racial disparity in odds of hospitalization and death from COVID-19. Researchers noted that, while the coronavirus has disproportionately affected racial and ethnic minorities nationwide, in their California study, infection, hospitalization and death were higher for Latinos, but not Black patients, relative to white patients.

The researchers point out that socioeconomic differences may confound racial and ethnic differences in testing and that “the role of sociodemographic, clinical and neighborhood factors in accounting for racial/ethnic differences in COVID-19 outcomes remains unclear.”

The study included data from more than 84,000 adult Medicaid patients at Contra Costa Regional Medical Center. The researchers hypothesized that, because all of the patients had Medicaid, “racial/ethnic disparities in testing and outcomes would narrow when controlling for demographics, comorbidities and ZIP code-level characteristics.”

They also expected that these characteristics would be reduced relative to previous studies, given similar insurance coverage, household income and access to health-care providers. Among their conclusions, the researchers highlighted that racial and ethnic disparities depend on local context, citing studies from other states with differing results.

“The substantially higher risk facing Latinos should be a key consideration in California’s strategies to mitigate disease transmission and harm,” they recommend.

“We learned a lot about testing and hospitalization disparities through this study,” Shah said. “We recently implemented a randomized controlled trial with our Contra Costa County partners to better understand vaccine take-up among the vaccine hesitant.”

Shah said that the research team is testing the role of financial incentives, reducing appointment scheduling frictions, and provider messages on COVID-19 vaccine take-up in this diverse Medicaid managed care population.

“We are excited to share the results from this vaccine take-up study very soon,” Shah said.

Additional authors include Mireille Jacobson, associate professor at the USC Leonard Davis School of Gerontology and senior fellow at the USC Schaeffer School for Health Policy and Economics; Tom Chang, associate professor of finance and business economics at the USC Marshall School of Business; Samir Shah, CEO of Contra Costa Regional Medical Center; and Rajiv Pramanik at Contra Costa Regional Medical Center & Health Centers, Contra Costa Health Service.

Study Measures Americans’ Growing Medical Debt

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Over the last decade, medical bills have become the largest source of debt that Americans owe collection agencies, according to new research co-authored by Associate Professor of Public Policy Wesley Yin. The $140 billion in unpaid health care bills, held by about 18% of Americans, now exceeds all other debt in collections combined, according to the paper just published in the Journal of the American Medical Association (JAMA). Only debts referred to collection agencies were measured; other unpaid bills owed to health-care providers would push the total amount of debt even higher. Yin and co-authors Raymond Kluender of Harvard Business School, Neale Mahoney of Stanford University and Francis Wong of the National Bureau of Economic Research examined records from the credit rating agency TransUnion from January 2009 to June 2020, reflecting medical care delivered prior to the COVID-19 pandemic. Their comprehensive look at the evolution of medical debt reveals that, while Americans’ household finances largely recovered after the Great Recession, medical debt continued to grow. Yin said the debt was most concentrated in low-income communities and in the South. He added that, in 12 states that chose not to expand Medicaid coverage, significant disparities grew even worse during the period studied. “Addressing the problem of medical debt in the U.S. health care system must be a high priority,” said the authors of a JAMA editorial accompanying the study. “In addition to the potential consequences for health and health care use, the economic and social ramifications of medical debt are likely equally consequential, if not more so.”

 

UCLA Model Identifies Neighborhoods Still at Risk as L.A. Reopens

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A UCLA team has developed a predictive model that pinpoints which populations in which neighborhoods of Los Angeles County are most at risk from COVID-19 and, by extension, which should be prioritized for vaccines. The research – COVID-19 Medical Vulnerability Indicators: A Predictive, Local Data Model for Equity in Public Health Decision Making – is published in the peer-reviewed International Journal of Environmental Health. With more than 10 million residents, Los Angeles County has a larger population than 41 U.S. states. While many have been vaccinated, others in neighborhoods and communities at high risk of COVID-19 must be reached to fully re-open Los Angeles County, the authors said. The model maps the county neighborhood by neighborhood, based on four indicators known to increase an individual’s vulnerability to COVID-19 infection: preexisting medical conditions, barriers to accessing health care, built-environment characteristics and socioeconomic challenges that create vulnerabilities. The research data demonstrate that neighborhoods characterized by significant clustering of racial and ethnic minorities, low-income households and unmet social needs are still most vulnerable to COVID-19 infection, specifically areas in and around South Los Angeles and the eastern portion of the San Fernando Valley. Communities along the coast and in the northwestern part of the county, which have more white and higher-income residents, were found to be the least vulnerable. The study was co-authored by Professor Paul Ong, Chhandara Pech and Nataly Rios Gutierrez of the Center for Neighborhood Knowledge at UCLA Luskin and Vicky Mays, a professor with the UCLA Fielding School of Public Health and UCLA College.

 

Yaroslavsky on COVID-19’s Stark Lines of Inequity

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Zev Yaroslavsky, director of the Los Angeles Initiative at UCLA Luskin, spoke to Spectrum News’ “Inside the Issues” about this year’s UCLA Quality of Life Index, which offered a deep dive into the impacts of COVID-19 on Los Angeles County’s residents. “There are two Los Angeleses,” Yaroslavsky said. “There are the people who are doing well, who are making it. … And then there are those who are struggling, who are living on the margins of the economy and are always feeling one step away from oblivion.” The index included the surprising finding that Latino residents were more positive about their overall quality of life than white residents. Yaroslavsky said this may be because white people on average had higher incomes and more to lose during this pandemic, despite their greater privilege overall. Latinos faced tough challenges but “they worked their way through it, and they are much more optimistic about getting ahead in Los Angeles,” he said.

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Torres-Gil on Building a California for All Ages

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Professor of Social Welfare and Public Policy Fernando Torres-Gil was featured in a Forbes article about Gov. Gavin Newsom’s Master Plan for Aging. The number of Californians age 60 and older is expected to nearly double from 6 million in 2010 to 11 million in 2030. One in five older adults in the state is living in poverty and older adults comprise the fastest-growing group of homeless individuals in California, Torres-Gil said. The Master Plan was also shaped by the COVID-19 pandemic, including recommendations to avoid prioritizing younger people with COVID-19 over older ones and acknowledging the disproportionate impact of the pandemic on older adults. “The pandemic really dramatized that certain populations were at terrible risk, especially Black and brown communities, low-income communities, older adults, nursing homes and skilled nursing facilities, and persons with disabilities and chronic conditions,” Torres-Gil said.

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