Going to see a doctor when you feel sick should be uneventful in the United States, the country with the highest health care expenditures per capita in the world (Congressional Budget Office, 2008). Yet, Mexican Americans do not benefit from the way health care is organized in the U.S., as health care access and work are linked. Simply put, Mexican Americans work, work should increase health care access through employer-based health insurance. Yet, working Mexican Americans show a high rate of being uninsured compared with other groups (Bhandai, 2002; Brown & Yu, 2002; Chávez et al., 1997; Fronstin, 2010).
This dissertation begins with a main assumption that the source of illness is social in origin, not just biological, and that the allocation of medical resources depends largely upon economic, political and social resources available to specific groups within society (Chávez et al., 1992; Chávez & Tones, 1994; de la Tone & Estrada, 2001; Doyal with Imogen Pennell, 1979/1994). I use a mixed-methods approach to better understand how the intersection of work and health care shape the experiences of Mexican Americans. I employ Logistic regression analysis on a subset (n=771) of data from a random phone survey conducted to examine health, employment and access issues among Latinos in California. Semi-structured in-depth interviews (n=15) were conducted in English and Spanish with employed Mexican origin respondents to examine health insurance and work histories, and other health care system experiences. Intersectional and political economy frameworks are used to investigate several questions. These include: (1) How does the organization and delivery of health care in the U.S. shape the access experiences of Mexican Americans? (2) What factors intersect with gender to shape health care access? (3) How do immigration status and citizenship shape access to health care for Mexican origin family members and what strategies are used to access care?
Findings suggest that health care access is a complex web of patterns, and varies along gender, nationality, citizenship and class lines. The working uninsured and undocumented have limited health care such as paying out of pocket via the patch work system. For U.S. residents and citizens, familiarity with the U.S. and Mexico health systems brings a type of "back up" plan which can be accessed if needs are not met in the U.S. Quantitatively, citizenship is an important predictor of health care access for women, while citizenship, work type and marital status are important factors for men. Citizenship and age are found to be important predictors of health care access in Mexico for women and all Mexico born respondents. These findings demonstrate the importance of examining health care access across different social locations.
This study has several policy and research implications. Any health reform legislation that is implemented needs to include a way to increase health insurance access for Mexican origin family members regardless of citizenship. Continuing to link health insurance with work is a barrier to health care for low income family members. Additionally, what I call "transnational health care" is an important avenue of further investigation. This study demonstrates the importance of ensuring affordable and accessible health care services for all.