Access to health care, Hispanic ethnicity, and border location in Texas

Reduced access contributes to health disparities, and Texas has the highest uninsured rate in the U.S. We compared coverage, no regular provider, and not seeking care because of cost for border counties with the rest of Texas using the 2007 Texas Behavioral Risk Factor Surveillance System. Data were analyzed using Stata 9.2 to take into account the complex survey design. The percentage without coverage in border counties was 41% compared to 23% in non-border locations and lacking a regular provider (40% vs. 27%). The percentage not getting care was 28% on the border compared to 18% non-border. Among Hispanics, coverage gaps did not differ by location (48% border; 45% non-border) or lacking a regular provider (44% in both regions). The percentage not getting care was 32% in border Hispanics and 28% among non-border Hispanics. Access barriers were less common in non-Hispanics. Among non-Hispanics, coverage gaps did not differ by border location (16% border; 17% elsewhere), but border residents were slightly more likely to lack providers (28% vs. 23%). The border subsample was asked about obtaining medications or medical services in Mexico. Hispanic border residents who lacked coverage were more likely to buy medications (52%) or seek medical care (33%) in Mexico than border Hispanics with coverage(32% and 14% respectively). Barriers to access along the international border with Mexico are largely accounted for by the difference in ethnic composition of border vs. non-border. To some extent, border residents are compensating for access problems by seeking services and medications in Mexico.