" (AAFP, nd) The Health Maintenance Organization further should "…negotiate with both public and private payers for adequate reimbursement or direct payment to cover the expenses of interpreter services so that they can establish services without burdening physicians…" and the private industry should be "…engaged by medical organizations, including the AAFP, and patient advocacy groups to consider innovative ways to provide interpreter services to both employees and the medically underserved." (AAFP, nd)

One example of the community healthcare organization is the CCOP model is reported as a community cancer screening center model and is stated to be an effective mechanism for facilitating the linkage of investigators and their institutions with the clinical trials network. It is reported that the minority-based CCOP was approved initially by the NCI, Division of Cancer Prevention Board of Scientific Counselors in January 1989. The implementation began in the fall of 1990 and the program was experiencing success by 1992. Success meant that the minority populations were made provisions of access to clinical trails and it is reported that in 2003, there were a total of eleven programs in eight U.S. states, the District of Columbia and Puerto Rico involving approximately forty hospitals and more than four hundred physicians, including over 100 minority investigators.

The minority-based CCOP initiative is stated to have a design which: (1) brings the advantages of state-of-the-art cancer treatment and prevention and control research to minority individuals in their own communities by having practicing physicians and their patients/participants enroll in NCI-approved cancer treatment and prevention and control clinical trials; (2) provides a basis for involving a wider segment of the community in cancer prevention and control research and investigates the impact of cancer therapy and control advances community medical practices; (3) increases the involvement of primary health care providers and other specialists with the minority-based CCOP investigators in cancer treatment and prevention and control research providing an opportunity for education and exchange of information; (4) facilitates wider community participation among racial/ethnic minorities, women and other populations through acceleration of the transfer of newly designed cancer prevention, detection, treatment, patient management, rehabilitation, and continuing care technology to widespread community application; and (5) examination of selected issues in Minority-based CCOP performance. (Department of Health and Human Services and the National Institutes of Health, 2004)

C. Hispanic-Americans Demographics and Other Vital Information

The work of Talamantes and Linderman (nd) entitled: "Health and Health Care of Hispanics: states that "The diverse use of the terms "Hispanic and Latino" in the literature can be attributed to the diversity of the subgroups of Mexican-American, Cuban American and Puerto Rican populations within a broader context. State and/or Regional differences in the use of terms are frequently noted in the Southwest. For example, in Texas where there is a large Mexican-American population, the identifiers Hispanic or Mexican-American are primarily used. New Mexicans usually self-identify as Hispanic or Hispanos. In California, Latino or Latina is typically the favored term. The term "Latino" emphasizes Latin American origin." According to the U.S. Bureau of the Census the term 'Hispanic' is used as an ethnicity category that refers to individuals who trace their origin or descent to Mexico Puerto Rico, Cuba, Central or South America, or Spain. Since 1980, according to the Census Bureau, Hispanics can be of any race." (Talamantes and Linderman, 2003)

Talamantes and Linderman additionally report that there is "substantial heterogeneity among the various Hispanic/Latino elder groups. They carry a unique historical and sociopolitical reality, which impacts who they are today. The subgroups vary by their patterns of geographic distribution in the United States. The Mexican-American population tends to reside in the Southwestern states of California, Arizona, Colorado, and Texas; the Hispanic population resides in New Mexico. The Cuban population predominantly resides in Florida, and the Puerto Rican population lives mostly in the Northeast with growing concentrations in New York, New Jersey and in major Midwestern cities such as Chicago." (Talamantes and Linderman, 2003)

Individuals in the United States who identify themselves as Hispanic or Latino is stated to equal 5.6% of all older Americans with an estimated 1,938,000 elders in this category in 2000. The population of Hispanic/Latino elderly is projected to grow 3.9% per year from 1990 to 2050. By 2020 they are expected to be 9% of all people 65 and older in the U.S., and by 2050 they will increase to 16.4%." (Talamantes and Linderman, ) The fact is that it is expected that the older Hispanic/Latino population will grow faster than any other ethnic minority group by 2028 even surpassing the non-Hispanic Black population in the elder aged category. The following figure is a chart that shows the ethnic distribution of Hispanic/Latino elderly in the United States.

Figure 1

Ethnic Distribution of Hispanic/Latino Elderly

Source: Talamantes and Linderman

The following figure is a chart showing the percent of population aged 65 and older by Ethnic group for Hispanic/Latinos in the United States.

Source: Talamantes and Linderman

The Hispanic origin population by gender, age and ethnicity...

Limited proficiency in English is stated to been a "barrier to accessing medical care and social services. (Mutchler & Brallier, 1999 cited in: Talamantes and Linderman, 2003)
Case Study on Health Maintenance Organizations

The work of Darrell J. Gaskin (1997) entitled: "The Impact of Health Maintenance Organizational Penetration on the Use of Hospitals that Serve Minority Communities" published in the Medical Care journal reports a study with the objectives of the examination of the penetration that health maintenance organization has made in making hospital markets more price competitive. Specifically stated is that "Hospitals in minority communities may be at a competitive disadvantage because they serve patients who are, on average, sicker and more likely to be uninsured or underinsured. This study estimated the impact of HMO penetration on the use of hospitals in minority communities during 1987 to 1992." (Gaskin, 1997)

The method of the study reported by Gaskin used a sample of 1,413 short-term general hospitals from the 85 largest metropolitan statistical areas" and it is reported that "…the determinants of hospitals' patient volumes were estimated. Hospitals located in predominately nonwhite neighborhoods were designated minority hospitals, and other hospitals were designated nonminority hospitals. Using regression analysis, the impact of HMO penetration and concentration on hospitals' patient volumes were estimated. Through interaction the HMO penetration and concentration variables with a minority hospital indicator variable, HMOs' impact on minority hospitals was calculated." (Gaskin, 1997) Results of the study report that health maintenance organization penetration was correlated with lower patient volumes in minority hospitals and higher patient volumes in nonminority hospitals." (Gaskin, 1997)

In addition it was reported that "competition in HMO markets was correlated with lower patient volumes for all hospitals. This effect was stronger for minority hospitals." (Gaskin, 1997) Conclusions of the study suggest that minority hospitals "may be at risk of losing patients as HMO penetration increases." (Gaskin, 1997) The study states that the health maintenance organization penetration was "correlated with lower patient volumes in minority hospitals and higher patient volumes in nonminority hospitals. Competition in HMO markets was correlated with lower patient volumes for all hospitals. This effect was stronger for minority hospitals." (Gaskin, 1997)

Case Study on Health Maintenance Organization Penetration and Payer Mix

The work of Kevin G.M. Volpp (2004) entitled: "The Effect of Increases in HMO Penetration and Changes in Payer Mix on In-Hospital Mortality and Treatment Patterns for Acute Myocardial Infarction" reports a study with the objective of determining whether changes in health maintenance organization (HMO) penetration or payer mix affected inhospital mortality and treatment patterns of patients with acute myocardial infarction (AMI). The study design is one in which an observational study was conducted through use of patient-level logistic regression analysis and hospital and year fixed effects of data from the Agency for Healthcare Research and Quality's Healthcare Costa and Utilization Project Nationwide Inpatient Sample, a geographically diverse sample of 20% of the hospitalized patients in the United States.

It is reported that managed care has grown and is a mechanism "to lower healthcare costs…" and is of the nature that has resulted in concerns that this may inadvertently have an adverse effect upon the quality of care. Additionally stated is that "relative reductions in payment may affect the quality of care because hospitals have fewer resources with which to provide services. The overall effect on patient care of declines in reimbursement by a specific insurer is stated to comprise two phenomena. (Volpp, 2004) Those two are listed as follows: (1) a direct effect on the care of patients with that particular insurance, who may receive fewer beneficial services, and (2) an indirect or spillover effect on other patients within the…