When seeking health care, immigrants face some challenges that are unique to the general population. Below is a list of the barriers that immigrants face when accessing health care. No regular source of care (more...) Cultural and linguistic barriers (more...) Service (more...) Access to affordable health insurance (more...) Awareness or perceptions of available health coverage options (more...) Experiences with health insurance or the health system (more...) Level of trust in government sponsored programs (more...) Complementary or alternative therapies (more...) Barriers for different immigrant populations: Children (more...) Within Immigrant Groups (more...) References No Regular Source of Care Many Hispanics in the U.S. lack a regular source of care: (1) Twenty-five percent of Hispanic people in the U.S. turn to community health centers for their regular source of care, compared with 8% of the overall population. (1) Forty percent of Hispanics (v. 20% whites, 24% total population) are without a regular doctor and 7% lack a regular source of care or use the emergency room as their regular source of care.(1, 2) Cultural and linguistic barriers Linguistic barriers to care are among the strongest barriers for immigrants. Among non-English speakers who said they needed an interpreter during a health care visit, only 48% said they always or usually had one.(3) Of those who were assisted by an interpreter (staff, family, friend), only 70 % fully understood what the doctor was saying.(3) Thirty three percent of Hispanics vs. 16% whites reported either: their doctor did not listen to everything they said, they did not fully understand their doctor, or they had questions but did not ask them.(1) Back to Top Service Twice as many Hispanics as whites (18% v. 9%) felt they had been treated with disrespect at their last doctor’s visit because of their race, ethnicity, inability to speak English, or pay for the visit.(1) Asians were the group who most often reported they had long waiting times for service approval from an insurance company (85% Asian vs.67%whites) and long waiting times for specialists (85% Asian vs. 74% whites).  Asians also most often reported having trouble obtaining treatment when needed (72% Asian vs. 55% whites).(4, 5) Asians give their health plans a fair/poor/very poor rating for ease of getting staff by phone, ease of scheduling appointments by phone, access to specialist when needed, lab tests ordered by primary physician, and ease of getting referral for mental health more than any other racial/ethnic group.(4) Access to affordable health insurance is a significant barrier for many immigrants.    Twenty-five percent of the 42.6 million Americans who are uninsured are Hispanic.(6) Most uninsured people (75%) are employed or are the dependents of employees.(7) A majority of the uninsured reported that they had a need for physician care and were prevented from seeking service by an inability to pay.(7) The chronically uninsured, and to a lesser extent, the temporarily uninsured use significantly fewer preventive or early-detection services than their insured counterparts. (7) A delay in use of primary care service may increase the need for a costly course of ambulatory treatment or hospitalization, outcomes that may increase the mental and physical suffering experienced by patients and may reduce the potential effectiveness of public policies that are intended to control spending of health services.(7) Compared with non-Hispanics, Hispanics were 85% less likely to have used care in the previous year that would have prevented illness or reduced risk.(8) Back to Top  Awareness or perceptions of available health coverage options can differ between immigrants and non-immigrants.  Due to a lack of information in print, radio, and video translated into different languages, many immigrants are unaware of low cost health coverage for which their children might be eligible.(6, 9) Many immigrants work for employers who do not offer coverage, or feel the costs are too high relative to benefits provided and the perceived need for care.(6)   An immigrant's degree of acculturation has an effect on whether he or she will use public assistance of any kind.(9) Forty-one percent of Hispanics say complying with doctor’s advice costs too much.(2)   Many people of color and non native speakers of English have had negative experiences with health insurance or the health system Eighteen percent of Hispanics (vs. 1 % of whites) believe they would have better care if they had been of a different race.(1)  Twice as many Hispanics as whites (18% v. 9%) felt they had been treated with disrespect at their last doctor’s visit because of their race, ethnicity, inability to speak English, or ability to pay for the visit.(1) More Hispanics than white non-Hispanics reported having experience barriers to care, and more than four times as many Hispanics felt their ethnicity/race was a barrier against receiving better care.(8)   Back to Top Level of trust in government sponsored programs A new federal law, the Illegal Immigration Reform and Immigrant Responsibility Act went into effect in December 1997.  It was highly controversial among the immigrant population. It established a requirement of any immigrant to the U.S. for an affadavit of support from a citizen willing to serve as sponsor to the immigrant.  Many sponsored immigrants expressed concern that the affadavit put their sponsor at risk of being sued for reimbursement of federally funded health care programs.(9)  Such concerns gave rise to a widespread belief that using health care would compromise immigrants' future ability to sponsor relatives.(9) Public charge is the determination by the Immigration and Naturalization Service (INS) or the State Department of an immigrants’ dependency on government assistance, resulting in denied admission to the U.S. or ineligibility for permanent resident status and possible deportation.(9)  The new standard, established in 1999, says only long term care can be a public charge; however, misunderstandings due to lack of available and understandable information and confidence in fidelity of government agents to the laws causes a great deal of fear in immigrants, leading many to avoid the risk they see in seeking health care.(9,10)     Complementary or alternative therapies   Without fully knowing their attitudes and behavioral practices, it can be problematic for health care professionals to properly diagnose and provide care for immigrants. One way people from various cultures differ from one another and from mainstream U.S. population is in their use of complementary and alternative therapies for health. Hispanics are more likely to use alternative therapies than whites (22% vs. 4%).(1)  Hispanics are nearly twice as likely as whites (30% vs. 16%) to say they use alternative therapies because it is a cheaper way of getting care.(1)  Only 50% of Hispanics compared with 70% of whites tell their doctor about their use of complementary therapies.(3) Back to Top Immigrant Children One-fifth of all children are immigrants (3%) or U.S. born child of immigrants (16%).(11) Roughly 85% of all immigrant families in the U.S. are of mixed status, where the parents are immigrants and their children are U.S. born.(12) Two recent studies by the Current Population Study, which asks about immigrant status, show that foreign-born children in the U.S. and residing in California are at a significantly higher risk of being uninsured than native-born children of immigrants or U.S. born parents.(13) Of 9 million Latino children nationally, 25% are uninsured.(13) In California, Hispanic children are 3 times more likely than whites to be uninsured.(13) The rate of uninsurance among U.S. born children of immigrant parents was two times that of immigrant children of immigrant parents and six times that of U.S. born children of U.S. born parents.(12) Language has also affected access to care for immigrant children.  Children whose survey was conducted in English were 2.6 times more likely to have regular source of care than children surveyed in another language.(14)   Immigrant Groups and Health Insurance Most government expenditure to immigrants is for the elderly, mostly those from European countries and Canada.(15) Immigrants from Central America, the Caribbean, Vietnam, and Korea are the most likely to lack health insurance coverage, while immigrants from Europe and Canada have the highest insurance rates. (15) Lack of health insurance for Caribbean, Central Americans, and Koreans is most often due to lack of employer coverage.(15) Refugees Other differences between immigrant groups are due to differences in refugee status.  Cubans and Russians accepted as refugees were granted educational opportunities, training programs, loans, direct cash, food allowances, and health care.(15) Immigrants from Guatemala and El Salvador, although fleeing political persecution, were not granted refugee status and therefore do not receive governmental assistance. (15) Back to Top References:   1. Doty M, Ives B. Quality of health care for Hispanic populations.  Findings from the Commonwealth Fund 2001 health care quality survey.  (Commonwealth Fund Pub. no. 526.)  New York City: The Commonwealth Fund, 2002.  2. Collins K, Hughes D, Doty M, et al. Diverse communities, common concerns: assessing health care quality for minority Americans.  Findings from the Commonwealth Fund 2001 health care quality survey.  (Commonwealth Fund Pub. no. 523.)  New York City: The Commonwealth Fund, 2002. 3. Doty M. Hispanic patients’ double burden: lack of health insurance and limited English.  (Commonwealth Fund Pub. no. 592.)  New York City: The Commonwealth Fund, 2003. 4. Snyder RE, Cunningham W, Nakazono TT, et al.  Access to medical care reported by Asians and Pacific Islanders in a West Coast physician group association.  Med Care Res Rev 2000 Jun;57(2):196-215.  5. The Healthy Community Collaborative of San Mateo County. 2004 Community Assessment: Health and Quality of Life in San Mateo County.  Redwood City, CA: The Healthy Community Collaborative of San Mateo County, 2004. www.plsinfo.org/healthysmc/201/access_to_health_care_services.html 6. Perry M, Kannel S, Castillo E.  Barriers to health coverage for Hispanic workers: focus group findings.     (Commonwealth Fund Pub. no. 425.)  New York City: The Commonwealth Fund, 2000.  7. Broyles RW, Narine L, Brandt EN, Jr. The temporarily and chronically uninsured: does their use of primary care differ? J Health Care Poor Underserved 2002;13(1):95-111. 8. Guendelman S, Wagner TH. Health services utilization among Latinos and white non-Latinos: results from a national survey. J Health Care Poor Underserved 2000;11(2):179-94. 9. Cook B. Building bridges: overcoming the barriers to enrolling immigrants and refugees in Massachusetts health insurance programs. MA: Health Care for All, 2000 Oct; www.accessprojects.org 10. Schlosberg C, Wiley D. The impact of INS public charge determinations on immigrant access to health care. http://www.nhelp.org/pubs/019980522publiccharge.html 11.Ku L, Matani S. Left out: immigrants' access to health care and insurance. Health Aff (Millwood) 2001;20(1):247-56. 12.Granados G, Puvvula J, Berman N, Dowling PT. Health care for Latino children: impact of child and parental birthplace on insurance status and access to health services. Am J Public Health 2001;91(11):1806-7. 13. Guendelman S, Schauffler H, Samuels S. Differential access and utilization of health services by immigrant and native-born children in working poor families in California. J Health Care Poor Underserved 2002;13(1):12-23. 14. Sonis J. Association between duration of residence and access to ambulatory care among Caribbean immigrant adolescents. Am J Public Health 1998;88(6):964-6. 15. Carrasquillo O, Carrasquillo AI, Shea S. Health insurance coverage of immigrants living in the United States: differences by citizenship status and country of origin. Am J Public Health 2000;90(6):917-23.     This research was supported by a National Library of Medicine (NLM) Publication Grant #5G08 LM07653-02 in support of the creation of a web site titled Factline: Tracking Health in Underserved Communities, www.factline.org. Saqi S. Maleque, MSPH, Researcher, Principal Investigator: Virginia Brennan, PhD.