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The health care system in the United States is the most expensive and yet arguably among the least cost effective in the developed world (Anderson, 1998). Despite the highest per person health care spending among the Organization for Economic Cooperation and Development (OECD) nations, the United States still ranks below many along a variety of health indicators (Woolhandler & Himmelstein, 1991). In a complicated health care system where the rules are many and economic forces drive both structure and function, the needs of vulnerable populations inevitably suffer. This chapter explores the consequences of these market forces on a vulnerable population--Latinos in the United States. First, the health insurance status of Latinos is reviewed in the context of employment trends and participation in various government-sponsored programs. Next, the chapter explores the impact of managed care on Latinos, as well as that of other institutional, organizational, and structural barriers that stand between this population and full access to health care.


This is the authors accepted version of a book chapter published in Health Issues in the Latino Community. Copyright © 2001 John Wiley & Sons. Printed with permission. All rights reserved. ISBN-13: 978-0787953157