When Routine Care Is Out of Reach, Latino Adults End Up in the Emergency Department

Latino adults who reported delaying or forgoing physical or mental health care due to cost had 78% higher odds of visiting an emergency department (ED) in the past 12 months, according to a study published today in JAMA Network Open.¹ The research analyzed data from 17,344 Latino adults who participated in the National Health Interview Survey between 2019 and 2024.

"Cost-related delayed or forgone care was associated with increased ED visits among Latino adults, underscoring the need for policies that reduce financial barriers to timely care," the authors wrote.

Insurance Gaps and Limited Care Access

Latino individuals make up 19.1% of the US population, about 63.6 million people, and remain disproportionately uninsured. The Affordable Care Act (ACA) reduced uninsurance rates among Latino individuals from 32.7% to 18.0% between 2010 and 2022, yet they still face higher uninsurance rates than nearly every other population group. In the study, 16.9% of respondents reported delaying or forgoing care due to cost in the prior 12 months.

Among those who did end up in the ED, rates of delayed and forgone care were substantially higher across all categories. Some 17.8% of ED visitors had delayed medical care, and 17.4% had forgone medical care, compared with 10.0% and 9.0%, respectively, among those with no ED visits. The gap was similarly pronounced for mental health care: 8.2% of ED visitors had delayed mental health counseling, and 9.1% had forgone it, vs 4.6% and 4.8% among non-ED visitors (all P < .001).

Groups With Higher Rates of Emergency Department Use

The study identified several groups within the Latino community with notably higher odds of ED use. In weighted multivariable logistic regression models, women had 33% higher odds of an ED visit than men (AOR, 1.33; 95% CI, 1.21-1.47). Those with less than a high school education had 60% higher odds compared with college graduates (AOR, 1.60; 95% CI, 1.34-1.92), and those with only a high school diploma had 59% higher odds (AOR, 1.59; 95% CI, 1.36-1.85). Respondents covered by public insurance had 69% higher odds than those with private coverage (AOR, 1.69; 95% CI, 1.49-1.91). Individuals reporting poor self-rated health had more than 4 times the odds of an ED visit compared with those in excellent health (AOR, 4.09; 95% CI, 3.05-5.48), whereas those in fair health had roughly twice the odds (AOR, 2.06; 95% CI, 1.74-2.43).

Geographic location also played a role, with metropolitan residents having lower odds of ED visits than nonmetropolitan residents. Non-Mexican Latino respondents had modestly higher odds than those of Mexican heritage (AOR, 1.18; 95% CI, 1.07-1.30). Latino adults born outside the United States had 25% lower odds of an ED visit than their US-born counterparts (AOR, 0.75; 95% CI, 0.65-0.86), and a significant 3-way interaction among delayed or forgone care, place of birth, and educational level showed that higher educational attainment was associated with lower ED visit probabilities across both groups (AOR, 1.15; 95% CI, 1.03-1.28; P = .02).

Financial Barriers and Their Effect on Emergency Care Costs

EDs are legally required under federal law to provide screening and stabilizing care to anyone, regardless of insurance status or ability to pay, making them a default entry point for those who cannot access routine care, but it comes at a high cost. US ED treatment costs grew from $54 billion in 2012 to $88 billion in 2019, a 5.4% annual increase.

Those costs are rising fastest for uninsured patients. A separate study published in The American Journal of Managed Care® found that self-pay ED facility fees increased approximately 9% to 10% between 2021 and 2023, outpacing medical inflation, with hospitals in counties with high proportions of uninsured Hispanic and Latino individuals raising self-pay prices at an especially sharp rate for high-acuity visits.²

The authors note that recent policy changes may worsen these disparities. Heightened immigration enforcement and Medicaid funding cuts are expected to increase uninsured rates and strain hospitals already managing high volumes of uncompensated care. The researchers call for targeted policies to reduce financial barriers to primary and preventive care for Latino adults.

References

1. Melgoza E, Falk DS, Vargas Bustamante A, Newberry JA. Cost-related delayed or forgone care and emergency department visits among Latino adults. JAMA Network Open. 2026;9(3):e260237. doi:10.1001/jamanetworkopen.2026.0237
2. Mouslim MC, Singh S, Henderson MA. Trends in hospital pricing for vulnerable emergency department users, 2021-2023. Am J Manag Care. 2025;31(12):775-780. doi:10.37765/ajmc.2025.89836